This is Part One of a three-part series summarising some of the public discussions about the September 11 Anniversary. This one focuses on renowned scientific journal, The Lancet, which recently published a special edition on the ongoing health problems arising from the suicide attack in the USA and from the consequent ongoing War in Iraq.

The Lancet reports that in addition to the 3,000 people who died in the September 11 attacks in 2001, there has been a reverberating impact on the physical, mental and public health of over 200,000 Americans.¹  I review papers on the health outcomes on the victims and the rescue crews who worked on the World Trade Centre site. I also discuss findings on the 43,000 suicide attack civilian casualties resulting from the Iraq war and a further 200 coalition soldiers. Finally, I include a brief review of the public health preparedness in the USA. Though this has drastically improved since the September 11 attacks, the ongoing economic crisis remains a challenge.

Thomas Farley and Isaac Weisfuse estimate that 35,000 to 70,000 survivors of the attack have probably developed post-traumatic trauma, including victims, rescue and recovery workers, passers-by and residents who were exposed to the event. A further 125,000 to 232,000 people have experienced respiratory illnesses.² Rachel Zeig-Owens and her colleagues report that New York fire fighters who responded to the attack are suffering from a ‘modest increase’ of cancer.³ The study compared the health outcomes of a sample of 9,000 fire-fighters who had been exposed to the 2011 World Trade Centre attack to a sample over 900 fire-fighters who were not exposed to this event, as well as to a health survey of 10,000 fire-fighters from 1996. The researchers find that fire-fighters who were exposed to the attack had a 10% higher rate of cancer than might be expected amongst a group of American men from a similar demographic background, and 32% higher rate than non-exposed fire-fighters.

The Lancet also published data on the casualties from the Iraq war, both the civilians and coalition soldiers, and the problems that medical teams in Iraq still face. Madelyn Hsiao-Rei Hicks and her colleagues finds that suicide attacks have significantly risen since the coalition forces’ military occupation of Iraq. There have been 1,000 suicide bomb attacks during 2003 to 2010; these attacks have killed around 12,300 Iraqi civilians and injured a further 30,600 civilians. Moreover, 200 coalition soldiers were killed in 79 suicide bomb events during this same time period. The research team argues suicide attacks in Iraq represent a major public health problem because they are ‘cost-effective, precise, [and] highly destructive’.⁴

Ali Khan reports that public health preparedness in the USA has drastically improved since the September 11 attacks, but the ongoing economic crisis remains a challenge.⁵ Over 44,000 jobs were cut from USA state and local health departments from 2008-2011. There are fewer public health specialists now than there have been in recent years, including doctors, nurses, laboratory specialists, and epidemiologists. Khan argues that budgetary changes and the shortage of skilled medical practitioners present a major problem should another terrorist attack occur in the USA or some other large-scale medical emergency.

To read the individual reports published by The Lancet, see the table of contents: http://www.thelancet.com/themed-911

References

1. For an overview of the Lancet special edition, see the Editorial: ‘9/11—New Data, Reviews, and Reflections’, The Lancet 378(9794): 850. Online resource last available 11 September 2011: http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611613974.pdf?id=e16241398b8eb460:3cdf9148:13257fabf9c:-6ac41315736810748
2. Farley, T. A. and I. Weisfuse (2011) ‘Redefining of Public Health Preparedness After 9/11’, The Lancet 378(9794): 957-959. Online resource last available 11 September 2011: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960969-0/fulltext
3. Zeig-Owens, R., et. al. (2011) ‘Early Assessment of Cancer Outcomes in New York City Firefighters After the 9/11 Attacks: An Observational Cohort Study’, The Lancet 378(9794): 898-905. Online resource last available 11 September 2011: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960989-6/fulltext
4. Hicks, M. H-R. (2011) ‘Casualties in Civilians and Coalition Soldiers from Suicide Bombings in Iraq, 2003—10: A Descriptive Study’, The Lancet 378(9794): 906-914. Online resource last available 11 September 2011: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961023-4/fulltext
5. Khan, A. S. (2011) ‘Public Health Preparedness and Response in the USA Since 9/11: A National Health Security Imperative’, The Lancet 378(9794): 953-956. Online resource last available 11 September 2011: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961263-4/fulltext

Image credit: Saucy Salad (2010) ‘September 11, 2010’. Flickr. Online resource last accessed 11 Sep 11: http://www.flickr.com/photos/saucysalad/4982672984/

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