The big news story on the fifth anniversary of 9/11 seems to be the discovery of the "abandoned heroes" and forgotten victims of the attacks. A New York Post reporter wrote about the "shocking truth": many people had gotten seriously ill from the poisonous dust that the collapse of the Twin Towers spread across lower Manhattan.

While the newly-published statistics may be shocking, the wider truth shouldn't be. None of this is really news. The first newspaper article citing a serious health risk appeared in October 2001. The thousands of people who have gotten sick – no one is sure exactly how many – have been talking about their problems since immediately after the Twin Towers collapse, while medical experts have published a wealth of material pointing to a connection between 9/11 and long-term health problems. But these voices were lost in previous anniversaries, obscured by the public ceremonies mourning those who died in the attacks themselves and the intense focus on the glass-and-steel rebuilding of Ground Zero.

This year, though, is proving to be much different.

In the first week of September, Mt. Sinai Medical Center released a major clinical study of 9/11 rescue workers, providing what Representative Carolyn Maloney described as a "concrete scientific link between the exposure to the toxins of Ground Zero and health problems." Hours later, Mayor Michel Bloomberg announced a wide-ranging plan addressing 9/11 health concerns, and within two days Representative Jerrold Nadler proposed federal legislation calling for free health care coverage for anyone whose health was affected by the attacks.

There are still more questions than answers. The scientific picture is far from complete. There is, for instance, no firm information about the health of people who live or work near Ground Zero. And while there has been the promise of action on all levels of government, it has yet to be seen whether the words will be followed with action.

Skeptics are also withholding their judgment about some of the high- profile pronouncements from government officials that help is on the way.

"You probably won't hear so much on September 12," said Catherine McVay Hughes, a member of lower Manhattan's Community Board One who has long pushed for a better response from all levels of government.

WHAT WE KNOW ABOUT 9/11 HEALTH PROBLEMS

The past several years have been filled with ominous signs for people who worked at Ground Zero, and for those who live and work nearby. The lung capacity of firefighters who worked at Ground Zero decreased an amount equivalent to over a decade's worth of aging in the year following 9/11. People who live downtown have been showing increased respiratory problems, and those with asthma have suffered from more severe symptoms. In the months after 9/11, the babies born at hospitals in lower Manhattan were smaller than average.

Those who worked at Ground Zero or in nearby offices developed a new condition: "World Trade Center cough." Many were forced to cut back on work, or retire. This January, police detective James Zadroga died of respiratory disease, becoming the first person whose death was officially attributed to a problem caused by work at Ground Zero.

Days before the fifth anniversary of 9/11, Mt. Sinai Medical Center published the findings of its monitoring program. Mt. Sinai's study looked at about 10,000 of the 40,000 first responders who worked at Ground Zero. Seventy percent of the Ground Zero workers the center tested between 2002 and 2004 reported respiratory problems while working at the site. Of those, 60 percent have had persistent respiratory problems.

These results are proof, many say, that the dust from 9/11 can be directly linked to serious health problems. Mt. Sinai's study, however, does not tell the whole story. It did not screen for cancer, or psychological problems. And its focus was entirely on rescue workers at Ground Zero – not people who returned to work in offices in lower Manhattan, or those who moved back into apartments nearby.

"The lower Manhattan residents are the forgotten of the forgotten," said Yuichi Tamano of Beyond Ground Zero, a group pushing for recognition of the wider health problems related to 9/11.

The city has established a registry to track the health of 71,000 people who may have been affected by the collapse of the towers. Nearly half of the adults, a group that includes first responders, office workers, and residents of lower Manhattan, have reported sinus or nasal problems. Over half of those who survived the collapse say their respiratory problems are worsening.

This registry is the best attempt to realize the full scope of 9/11-related health problems, but critics say it is not very good. It is based on of people's own assessments of their health, they say, and registry researchers often don't ask relevant questions. Environmental activists, members of the city's congressional delegation, and downtown residents all say that there is a health crisis that extends beyond those who worked at Ground Zero. But the dimensions of that crisis remain cloudy.

GOVERNMENT ACTION AT LAST?

Julian Felipe stood across the street from Ground Zero in early September, pointing out the buildings from which he cleaned dust in the fall of 2001. Like many of the people called upon to clean these offices, Felipe moved here from another country (in his case Mexico). He speaks no English, and does not have health insurance. And, like many of those who worked alongside him, Felipe doesn't do physical work any more. He is too sick.

Felipe speaks quietly, his voice nearly drowned out by the chanting of hundreds of people surrounding him, his fellow participants in a rally for federal action to address their health problems.

"What we want is for the government to listen to us, to see the sicknesses that we have. Those who came to work here didn't know the problems we would have now," he said in Spanish. "If we would have known, we wouldn't have come to work."

Felipe's request – that the government simply acknowledge that there is a 9/11 health problem – is a testament to how little has been done. Now officials say they are planning to make up for lost time.

For his part, Felipe is skeptical. "They have told us before they would help us," he said. "But they have not."

City Hall

New York City officials have been slow to acknowledge that the collapse of the Twin Towers posed a lasting danger to city residents. Then-mayor Rudolph Giuliani encouraged people to return downtown. Mayor Michael Bloomberg has been questioning the idea that sicknesses can be directly linked to 9/11. Bloomberg's arguments seem tied to his reluctance to open the city up to widespread 9/11-related workers compensation claims. The city has been contesting many such claims, and has opposed efforts to extend workers compensation benefits for people who worked at Ground Zero.

On the last day of this August, city officials changed their tune when they announced that they would send clinical guidelines to doctors citywide about how to diagnose and treat adults exposed to the collapse of the Twin Towers. There have been calls for such guidelines since late 2001, and there has been no small amount of frustration about the years of delay. Critics say that people's health has suffered as a result. But city officials have argued they had to wait until there was scientific evidence linking the dust to specific diseases.

The release of the guidelines, presumably, was acknowledgement that of such evidence. Within days, though, the city backtracked. "I don't believe that you can say specifically a particular problem came from this particular event," he said.

Early this month, Bloomberg presented a broad plan for tracking and treating 9/11-related health cases – despite his doubts that such cases had to do with 9/11. The city will set aside $16 million to the Health and Hospitals Corporation – the agency that runs the city's public hospitals – to develop a specialty World Trade Center clinic providing free care to Manhattan and Brooklyn residents exposed to 9/11 dust. The clinic is scheduled to open in January 2007.

The city's health department will increase World Trade Center health monitoring, putting aside $12.6 million to do so, and is increasing the staff of its WTC Unit from 7 to 20 employees.

The mayor's office is also creating an internal panel to coordinate city responses to 9/11.

Bloomberg says the city can't be asked to shoulder the burden itself, however. He called for state and federal governments to help fund long-term monitoring and treatment programs.

Bloomberg's inconsistency has confused some who are involved in the issue, but they are hoping that his actions speak louder than his words.

"[The mayor] opened the medical clinic that is going to be open not only to the rescue workers but to residents and small business people," said Suzanne Mattei of Sierra Club. "That's a very significant new development because no government entity has done that."

Others describe the plan as a good first step. But because it lasts for only five years, the program will not be sufficient to deal with long-term health problems. No one believes that the city can confront this issue alone.

Albany

New York State's workers compensation program has been one of the only sources of help for people suffering from 9/11-related health problems. But the state's program has been criticized for denying people from benefits. Mattei's says the state has held people filing claims to an "unreasonably difficult burden of proving that their illness was caused by 9/11 pollution – even though they were healthy before the attack and only became ill after their Ground Zero work."

In any case, the time to apply for such benefits had passed. Those with newly emerging problems were ineligible for state aid.

In August, Governor George Pataki addressed these cases, signing a law that allowing Ground Zero workers more leverage in applying for existing workers compensation benefits. Some praised the law for increasing the benefits available. But it was also criticized for putting the financial burden largely on the city. Others saw it as a minor gesture at a time when an increasing amount of evidence showed that the problems are far worse than initially reported. Others complained that it fails to address the health problems of downtown residents.

The recent revelations about the extent of the health problems are likely to push the issue higher on Albany's list of priorities, said State Assembly Speaker Sheldon Silver.

In early September, Silver said that "it's premature" to decide how the health of residents should be approached, but that a response from some combination of city, state, and federal governments should be forthcoming. He suggested basing such an effort on the Mt. Sinai program for rescue workers.

"It's clearly a major priority for the [next] governor," said Silver. When pressed about who would fund such an effort, Silver said that "it should be funded by everybody."

Washington

The federal government has shouldered much of the blame for the failure to confront post 9/11 health problems. The Environmental Protection Agency's assurances that lower Manhattan was safe to breathe despite having evidence to the contrary has been deemed "the big lie", a shocking example of a government unconcerned with the health risks associated with the toxic dust that coated lower Manhattan.

Since then, the federal government's response has been practically nonexistent.

But many say that only the federal government has the resources to respond. The city's congressional delegation has been pushing for a more active approach. To date, its efforts have not been overwhelmingly successful.

Late last year, Washington set aside its first funding for 9/11 treatment programs -- $75 million – but that money has not been released. Representatives Maloney and Vito Fosella pushed for a "Health Czar" to coordinate a federal response. In February, John Howard was appointed to the position, but has since referred to himself as a "czar without a budget." In early September, the Health and Human Services Secretary said he was appointing a task force to further examine Washington's response.

"I welcome this commitment from the secretary, but quite frankly the sick responders of 9/11 don't need another task force or another point person," said Maloney. "They need medical monitoring and treatment."

On September 7, Representative Jerrold Nadler introduced a bill that would extend Medicare benefits to anyone whose health has suffered because of the attacks. Further, he would exempt them from the premiums, deductibles, and co-payments that regular Medicare recipients are responsible for. The bill would also establish a consortium of experts to continue to research 9/11 health conditions for the federal government.

Nadler said that the bill is not likely to be considered before this fall's elections, but he hopes to pick it up when Congress returns to session in January. When it does, its cost will probably prove to be a major issue.

"We don't have a precise cost estimate because we don't know how many people will get sick over the next 40 years," said Nadler. "But off the top of my head I'd say this will cost several billion dollars."

Nadler says the federal government has a moral obligation to right the problems it has created through a response marked by "lies an deceit, and a deliberate decision to not enforce environmental laws." But he says that much of the damage is irrevocable.

"We may see more deaths as a result of the government's inaction than as a result of the attacks themselves," he said.