Detective James Zadroga was inside 7 World Trade Center on the morning of September 11, 2001. He escaped –- barely –- when the building collapsed. But Zadroga could not escape the damage done to his body by the hundreds of hours he spent at Ground Zero cleaning up the rubble in the following weeks. On January 5 of this year, Zadroga died from lung disease and mercury poisoning – a condition that hasn't been a widespread occupational hazard for over a century when hatters were sickened as they dyed beaver pelts.

Working at Ground Zero seems to have been even more dangerous than initially suspected, say health researchers. At least two Ground Zero rescue workers besides Zadroga –- and maybe more than twenty -– have died from illnesses that seem to be related to working on "the pile" (rescue workers' nickname for the rubble of the twin towers). But James Zadroga's death in particular has redirected attention to a problem that, experts say, will likely continue for decades.

Efforts to confront the health effects of 9/11 have not progressed quickly. Federal attempts to determine how far dangerous chemicals spread have sputtered along, enraging many local residents and environmental activists, who suspect that the towers' collapse spread contaminants across lower Manhattan and parts of Brooklyn. A registry set up to collect data on health trends covered a more limited area, and there is currently no way of knowing how many people are sick with 9/11-related illnesses.

The approximately 40,000 rescue workers are probably the one group at greatest risk, because those who worked on the site were directly exposed to these chemicals at very close range for long periods of time. Zadroga spent 470 hours at Ground Zero. But as they get sick and even die, public officials have had little success tracking their health, much less treating them.

This month, the New York congressional delegation called on the federal government to appoint a 9/11 health czar, whose first responsibility would be to find a way to track and confront the health problems rescue workers are facing. Until that happens, private screening and treatment programs are struggling to do what they can.

MONITORING AND TREATING PROBLEMS

Vincent Forras, a volunteer firefighter from Westchester County, was dispatched to Ground Zero immediately after the attack. He ended up working on the site for three weeks, spent two hours buried alive in the rubble of the South Tower, and later received the Ground Zero Service Medal.

Rescue workers had difficulty breathing soon after arriving at Ground Zero, said Forras. So, he said, "they juiced us up with all kinds of Albuterol and various medications to keep us breathing." This allowed rescue workers to continue working on the pile, where they filled their lungs with lead, mercury, asbestos, and pulverized cement and glass.

When Forras breathes now, he feels like he is "drowning in air."

He lists his other problems: He has "World Trade Center Cough", a symptom of Reactive Airway Dysfunction Syndrome. He is producing too much phlegm, has massive headaches, sinus problems, and symptoms of heart disease. More than four years after 9/11, his wife is still picking pieces of glass out of his skin.

Forras had his problems diagnosed at Mt. Sinai's World Trade Center Medical Monitoring Program, run through its Center for Occupational and Environmental Medicine. This program has screened the health of 16,000 men and women who worked on the pile, and is the largest effort to monitor the health of rescue workers at Ground Zero. The screening program is federally funded, and is open to anyone who worked at Ground Zero, whether they show symptoms or not, with a few exceptions: New York City firefighters – who have their own monitoring program – are ineligible, as are federal workers. Federal workers currently have no options for screening or treatment.

About half of the people that have come to Mt. Sinai for diagnosis have respiratory diseases, sinus or throat problems, or post-traumatic stress disorder.

Dr. Robin Herbert, who is the director of both the screening and treatment programs, continues to be taken aback by the severity of the medical problems like those afflicting Forras. She also feels overwhelmed by the problems involved with getting treatment for those her program screens. Mt. Sinai refers people who need treatment to its own program, which is overburdened, and has managed to see only 1,800 patients. It doesn't have the resources to see any more.

Private philanthropists currently provide all the money for treatment. The Red Cross gave $20 million to fund several such programs, and the lion's share of the Mt. Sinai's program comes from this pool of money (though donations like the $100,000 it received from a church group in Ohio, or $2,000 worth of pennies raised by children in Queens also help).

Mt. Sinai estimates that 5,000 people it has diagnosed as sick are not getting necessary health care. "It's pretty consistently the case that demand has tended to exceed our capacity," said Herbert.

WHERE IS THE GOVERNMENT?

The Red Cross sees its role as a stopgap measure, operating only until a more systematic public program can be put in place. It will stop its funding next year.

But interest from government is underwhelming. In his State of the City speech this month, Mayor Michael Bloomberg mentioned major plans for Ground Zero and for health care. He did not, however, connect these two themes. New York State government has provided treatment for those who worked on the pile with access to its worker's compensation program -– even if they came from out of state -– but its resources are limited.

It is the federal government's inactivity, however, that has most angered those involved with providing health care to 9/11 rescue workers.

There were 10,000 federal employees among the rescue workers at Ground Zero. The federal government set up its own medical monitoring program for these workers, but closed it down after screening only about 400 people. Federal employees cannot seek help through other programs; instead, they must wait for this program to be restored.

If the federal government has been lackluster in screening for health problems, its treatment program is nonexistent. To date, no federal money has been dedicated to treatment for any 9/11 rescue workers.

Some lawmakers in Washington are trying to change this. In December, Congress restored $125 million for funding for 9/11-related health issues that the Bush administration had cut from the budget. New York State's workers compensation program will get $50 million, with the remaining $75 million spent on existing monitoring and treatment programs. For the first time, this money will be available to be used not only to monitor workers' health, but also to treat their problems. It is not yet clear, however, when it will reach those who need it or how it will be split among monitoring and treatment programs.

On January 25, the New York Congressional delegation sent a letter to federal Health and Human Services Secretary Michael Leavitt asking him to appoint a "9/11 health czar" (letter in pdf format). So little has happened, they argue, because there is not a single person who is directly responsible for addressing 9/11 health issues.

Representative Carolyn Maloney and Vito Fossella recently called a press conference at Ground Zero to push for the idea. A position should be created within the department of Health and Human Services whose work would start with the establishment of "an exhaustive medical screening, monitoring, and health care program for all responders exposed to the toxins," said Maloney, encircled by men and women in fire department jackets or hats from local ironworkers unions. One had lost half a foot; another had lost almost a third of his lung capacity.

After Maloney finished, Forras stepped forward to talk about his battles with daily treatments, and about his feeling that the care he needed wasn't out there. He fully expected to die, he said, "sooner than later."

"I can guarantee you than when we come back here next year, some of these people will not be standing here," he said of those surrounding him. "You will find shadows of people."