Rescuers needed only five seconds. Politicians needed several dozen years.

On the morning of September 11, 2001, young detective James Zadroga was returning home after a night shift. He was just a few minutes away from his family home in New Jersey when he heard on the radio that a plane had hit the World Trade Center. He immediately turned back and went to Lower Manhattan to help evacuate the building. That same afternoon, he miraculously escaped death when World Trade Center 7 – a smaller building damaged by fire and falling debris from the two main towers – collapsed.

Over the following months, Zadroga worked hundreds of hours in Ground Zero, initially searching for survivors, then removing debris. He did so wearing a paper dust mask, which can be purchased at hardware stores.

He was not alone. In the first days after the disaster, appropriate protective measures were lacking, traditional firefighting equipment proved insufficient given the scale of the catastrophe, and blocked access roads and communication chaos delayed the delivery of specialized equipment. The Environmental Protection Agency issued a statement at that time, assuring that outdoor air was not hazardous. As a result, many rescuers worked without proper respiratory protection.

In the dust inhaled by rescuers, there was powdered concrete, gypsum, fiberglass. Burning aviation fuel, cables, electronics, and fluorescent lamps released asbestos, lead, mercury, chromium, nickel, zinc, and cadmium.

Ground Zero was not the only place where rescuers worked. Nearly two million tons of debris were transported by trucks and barges to Fresh Kills, a former waste dump on Staten Island, one of New York City's five boroughs, located on an island about eight kilometers from Manhattan, across the bay. For months, thousands of firefighters, police officers, municipal workers, and volunteers sifted through debris searching for human remains, personal belongings of victims, and aircraft wreckage that could serve as evidence in the investigation.

A few weeks after the attack, Zadroga's health began to deteriorate. The detective had difficulty breathing and suffered from a persistent cough. He also experienced insomnia and headaches.

In March 2002, he informed his employer that his ailments were related to his service. According to James's family, the report was ignored, and the policeman had to continue reporting to work despite being unable to even climb stairs.

The New York Police Department did not respond to the allegations made by James's family. There is also no conclusive evidence that Zadroga's health condition was downplayed by his superiors. However, it is known that a few months after reporting his ailments, Zadroga was transferred to the homicide division in Lower Manhattan. Soon after, he went on medical leave.

His condition continued to worsen: he was no longer able to work, began moving in a wheelchair, needed an oxygen tank, and regular injections. In October, tests showed that his lungs were functioning at only half of normal capacity.

Zadroga applied for disability pension. The police medical board found him unfit for work but refused to confirm that this incapacity was a consequence of his official duties. “I can't pay my bills, and my employer refuses to acknowledge that I am sick. They remember the dead, but not the sick who are still alive,” he bitterly stated in a written statement.

Over the following months, Zadroga was examined multiple times. Ultimately, in 2004, it was recognized that his dramatic health condition was a result of working in Ground Zero, and he was granted a disability pension. On January 5, 2006, Zadroga died from respiratory failure caused by severe granulomatous pneumonia.

In April 2006, New Jersey medical examiner Dr. Gerard Breton stated that the policeman's death was directly related to work at Ground Zero. This was the first official medical evidence linking a rescuer's death to dust exposure. However, this was not the end.

Zadroga's parents submitted the autopsy results to the Office of the Chief Medical Examiner of New York City. However, acting chief Dr. Charles Hirsch challenged the findings and suggested that lung damage could have been caused by intravenous injection of powdered medications that Zadroga was taking due to his severe illness. This version was opposed by forensic pathologist Michael Baden, who pointed out the presence of glass fibers in the lungs, which the theory of drug injections could not explain. There were also no signs of injections on Zadroga's body.

Meanwhile, thousands of sick rescuers fought for help in covering their medical expenses.

Eleven days after the attack, Congress established a compensation fund for September 11 victims. It paid compensation to the families of victims and those injured in the attacks, among other reasons, to protect airlines from lawsuits. In exchange for accepting compensation from the fund, victims usually had to waive the right to pursue legal action.

However, compensation was only available to those who suffered injuries directly in the attacks. The fund expired in 2003, before the chronic illnesses of thousands of rescuers began to fully manifest.

Rescuers tried to draw the attention of politicians and the media, and also joined class-action lawsuits against the city. Questioning the cause of Zadroga's death was seen as an attempt to shield against lawsuits. The “Daily News” published an article accusing Hirsch of tarnishing Zadroga's reputation. The case gained publicity.

In 2005, Democrat Carolyn Maloney introduced a bill providing funds for research and treatment of those who fell ill after serving in Ground Zero. However, the bill did not gain enough political support.

A year later, Maloney submitted the so-called Zadroga Act. At the same time, Senator Hillary Clinton attempted to include a five-year healthcare program worth $1.9 billion into the Homeland Security bill. Both initiatives were again blocked during committee work. Their Republican opponents argued that passing them would create a huge, unfunded federal healthcare program, and claimed there was still insufficient evidence linking work at Ground Zero to chronic illnesses.

On February 4, 2009, another version of the bill was introduced. Democrats tried to pass it via a fast-track process requiring a two-thirds majority. Republicans opposed, criticizing the funding mechanism: the elimination of the corporate tax loophole used by foreign companies operating in the U.S. Ultimately, the bill was passed by the House of Representatives in a regular vote and sent to the Senate.

Once again, Republicans blocked the bill, employing parliamentary obstruction. It was not only about costs. By the end of 2010, the tax cuts introduced during President Bush's administration in 2001 and 2003 expired. Republicans announced they would block further legislation until the Senate extended these tax cuts. As a result, the Zadroga Act became part of an ongoing dispute over taxes and federal spending.

On December 16, 2010, host of the popular The Daily Show, Jon Stewart, invited four Ground Zero responders to the program. They explained that the insurance provided by their employer did not cover their treatment costs and that they did not understand why politicians could not pass a law guaranteeing them healthcare for years. Stewart said little but played a poignant recording in which a Republican senator explained that legislating between Christmas and New Year would mean “disrespecting the institution and the holidays.” The studio responded with a murmur of disbelief.

“You won't find a single New York firefighter who considers working on New Year's Eve or New Year's Day as a sign of disrespect,” concludes firefighter Kenny Specht, who has cancer.

Major TV stations immediately covered the issue. Criticism crossed ideological lines. Chris Wallace, host of Fox News Sunday, called the failure to pass the law a “national disgrace.”

Three days after Stewart's program aired, New York senators Chuck Schumer and Kirsten Gillibrand expedited the passage of a revised, scaled-down version of the bill. To satisfy Republicans, they changed the funding mechanism – part of the costs would be covered by introducing a two percent excise tax on certain foreign goods instead of eliminating tax breaks for corporations. They also limited its duration to five years. On December 22, 2010, the Senate unanimously approved the Zadroga Act, and on January 2, the law was signed by Barack Obama.

Five years later, the law expired, and the fight restarted. Rescuers and their families traveled to Washington to persuade Congress to extend the law. Stewart joined them. “I want to see if shame works. Shame is a feeling that might overwhelm a senator who, after 9/11, tweeted: ‘We will never forget our heroes,’ then forgot about them by not supporting this law,” Stewart said, stopping politicians in the Capitol corridors.

Pressure again bore fruit. On December 18, 2015, Obama signed a law extending healthcare programs until 2090 and prolonging the compensation fund for another five years.

In June 2019, the fund began to limit payments to dying rescuers. Stewart once again visited the Capitol, this time testifying before the subcommittee on the compensation fund. Sitting next to the incurably ill NYPD detective Luis Alvarez, he addressed the legislators:

“The response time of New York emergency services to the 911 call was five seconds. There isn't a single person here who wouldn't tweet: ‘We will never forget the heroes of 9/11.’ Well, here they are! Your indifference cost these men and women their most precious resource: time. It should be the other way around: Congress members should be questioned and explain why this is so damn difficult and takes so damn long. I can't understand why this law hasn't been passed unanimously. They responded in five seconds. They did their job with courage, dignity, perseverance, and humility. Eighteen years later – you do yours!’”

Detective Luis Alvarez died just 18 days later. Stewart's speech once again became one of the most prominent moments of the campaign for the fund. On July 23, the Senate approved its permanent funding by a vote of 97 to 2.

The fund, along with the World Trade Center Health Program, which provides monitoring and treatment for illnesses resulting from the attack on the World Trade Center, is set to operate until 2090.

Among rescuers, the incidence of asthma increased from about three percent before September 11 to 19 percent in 2007. In the general adult population of the United States, this rate remained around 10 percent. The prevalence of chronic rhinosinusitis doubled.

Compared to the general population, rescuers had a 9 percent higher risk of developing cancer. For prostate cancer, the risk was 25 percent higher, for leukemia 41 percent, and for thyroid cancer as much as 119 percent. Firefighters who arrived at the scene during or immediately after the buildings collapsed had a 44 percent higher risk of cardiovascular diseases than those who arrived on September 12 or later.

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