Twenty years after Lower Manhattan was covered in toxic dust from the World Trade Center, health problems persist for survivors and first responders at the Twin Towers, and for residents who lived nearby.

According to the Associated Press, 111,000 people are part of the World Trade Center Health Program, which provides free medical care to persons with health problems possibly tied to the dust.

Per the AP:

To date, the U.S. has spent $11.7 billion on care and compensation for those exposed to the dust -- about $4.6 billion more than it gave to the families of people killed or injured on Sept. 11, 2001. More than 40,000 people have gotten payments from a government fund for people with illnesses potentially linked to the attacks.

Scientists still can’t say for certain how many people developed health problems as a result of exposure to the tons of pulverized concrete, glass, asbestos, gypsum and God knows what else that fell on Lower Manhattan when the towers fell.

The AP also reports:

The largest number of people enrolled in the federal health program suffer from chronic inflammation of their sinus or nasal cavities or from reflux disease, a condition that can cause symptoms including heartburn, sore throat and a chronic cough.

The reasons for this are not well understood. Doctors say it could be related to their bodies getting stuck in cycles of chronic inflammation initially triggered by irritation from the dust.

AP further notes:

Post-traumatic stress disorder has emerged as one of the most common, persistent health conditions, afflicting about 12,500 people enrolled in the health program. Nearly 19,000 enrollees have a mental health problem believed to be linked to the attacks. More than 4,000 patients have some type of chronic obstructive pulmonary disease, a family of potentially debilitating breathing problems.

Time has helped heal some physical ailments, but not others. Many first responders who developed a chronic cough later had it fade, or disappear entirely, but others have shown little improvement.

About 9% of firefighters exposed to the dust still report a persistent cough, according to Fire Department research. About 22% report experiencing shortness of breath. About 40% still have chronic sinus problems or acid reflux.

Tests on Fire Department personnel who spent time at ground zero found that their lung function declined 10 to 12 times greater than the rate normally expected due to aging in the first year after 9/11.

In the two decades since 9/11, there has been some disagreement between physicians and patients exposed to dust. Some patients are positive that their ailments are directly due to 9/11 dust, but some doctors are not as convinced. Many of those registered in this health program have conditions which are common among the public generally, such as sleep apnea or acid reflux. More, there often isn’t a test to determine whether sickness is linked to the toxic dust, or because of other factors, such as smoking, AP said.

Some doctors believe that illness and death linked to the dust could have been much worse. Nearly 24,000 people exposed to the dust were diagnosed with cancer over the past 20 years. This number is mostly in keeping with the rate researchers usually see among the general public, AP notes. Some types of cancer—such as malignant melanoma, thyroid cancer, and prostate cancer—have seen slightly elevated rates among those exposed to dust. Some researchers think this increase could be linked to additional diagnoses, due to ongoing medical monitoring initiatives.

“We really don’t have the tremendous elevations in cancer I was afraid of,” Dr Michael Crane, director of the World Trade Center health clinic at Mount Sinai, reportedly said. “I was terrified that we were going to have epidemic lung cancer.”

The Bidens, Harris, and Emhoff are seen laying a wreath at the Pentagon.

General Mark Milley, chairman of the Joint Chiefs of Staff, and Lloyd Austin, secretary of defense, are also present at this ceremony.

President Biden and First Lady Jill Biden have arrived at the Pentagon for a wreath-laying ceremony to remember 9/11 victims. Vice president Harris and Second Gentleman Doug Emhoff are also in attendance.

Muslim Americans in the arts, politics, education, media, and healthcare spoke with The Guardian’s Erum Salam about their experiences following September 11. Many Muslim Americans contended with years of racism and sometimes hate-fueled violence, after the 9/11 attacks. Muslim communities underwent intrusive government surveillance at mosques, schools, workplaces, and homes.

The comedian Mo Amer, one of the Muslim Americans who spoke with The Guardian, recalled:

“It’s impossible to forget how I felt after 9/11, the worry and anxiety. At that point, I had lived 10 years in America as a refugee, still in the asylum process. It was devastating as a comedian and entertainer with my Palestinian Muslim background in the south. People were telling me that my career was over. That no one wanted to see a Muslim named Mohammed on stage. I was very scared.

My mom woke me up when the first building was hit. And then as we saw the next plane come in and the explosion, we’re like, “Oh my God, this wasn’t an accident.” It just blew us away. My mom and I were both in tears, watching people jumping out of buildings.

The saddest part of it all was that there were so many victims. I remember calling my friends in New York. My buddy Kenny, who was studying at NYU, and my buddy Andrew. My friend Pete Davidson lost his father because of 9/11.

Just hearing the sirens in the background – I get chills and choked up thinking about it.

It was a really traumatic thing that New Yorkers went through, that all of us as Americans went through. And particularly, Muslims were probably traumatized throughout that time for sure.

People were mentioning camps and putting Muslims in camps. They were referencing world war II and the Japanese [internment] camps. It was absurd.

It was painful because that’s not what Islam is. It goes against everything within Islam. It was being used and politicized. I hate the [terrorists] so much. As a believing Muslim, as someone who truly believes in a divine existence and a God over the entire universe, this is not what it’s about. Spirituality is oneness to me: one human race.

So that was very, very frustrating. It’s very sad. There’s nothing funny here.

What makes it more disgusting upon everything is that they decimated Iraq for this and it had nothing to do with it. All these innocent people died over politics.

Former president Donald Trump visited New York City police and fire department stations this afternoon—and teased the possibility of a political run during one visit. During Trump’s “surprise” appearance at one police precinct, he reportedly said: “What an incredible job you do.”

“I grew up with you and you are New York’s finest,” The Hill quoted Trump as saying. Trump also praised the Police Benevolent Association, the largest union of rank-and-file NYPD officers. The association endorsed Trump in the 2020 election, flouting a long tradition of not backing candidates.

“First time they’ve ever endorsed a candidate for president,” Trump reportedly remarked. “And it’s a great honor.”

“Having that endorsement meant more to me than anything, so I really appreciate it.”

Posts on social media also indicate that Trump visited a firehouse.

Trump, who didn’t join other US presidents at ceremonies marking the 20th anniversary of 9/11, used one of these visits to discuss his political career.

When a police officer asked Trump whether he would run for political office again, video from Sky News shows him saying: “We’re not supposed to be talking about it yet...but I think you’re going to be happy.”

During Biden’s stop at the Shanksville, Pennsylvania fire station, he also discussed the increasingly acrimonious state of political dialogue in the US.

“A number of serious Republicans, in the past and a few who are still around, call me and tell me, ‘what can I do to help?’ Because they get it too. They may not agree with everything I say, but this idea that, you know, ‘What do you want to do with Biden, I want to box him,’” the White House travel pool reporter quoted Biden as saying.

Biden then crossed himself and remarked: “I should be so lucky.” The president also alluded to “stuff that’s coming out of Florida”. The state’s governor is Republican Ron DeSantis, a Trump ally who has politicized coronavirus as the state reels from surging infections and deaths.

He also referred to Trump’s statement praising Robert E Lee, the slave-owning general who led the Confederate army against the United States during the Civil War. (Earlier this week, Trump had remarked in a statement: “If only we had Robert E Lee to command our troops in Afghanistan, that disaster would have ended in a complete and total victory many years ago. What an embarrassment we are suffering because we don’t have the genius of a Robert E Lee!”)

The Confederacy did not win the civil war.

Biden indicated shock at how crude political language had become.

“They think this makes sense for us to be in this kind of thing where you ride down the street and someone has a sign saying ‘F so and so?’”the pooler quoted Biden as saying.

Biden also remarked it was a mistake that the US tried to unite Afghanistan after killing Osama bin Laden. “Could al-Qaida come back? Yeah. But guess what? It’s already back other places. What’s the strategy? Every place where al-Qaida is, we’re going to invade and have troops stay in? C’mon.”

Biden also defended the withdrawal of US troops from Afghanistan several weeks ago.

“It’s hard to explain to anybody, how else could you get out. For example, if we were in Tajikistan and pulled up a C-130 and said we’re going to let, you know, anybody who was involved with being sympathetic to us to get on the plane, you’d have people hanging in the wheel well. C’mon,” Biden reportedly said.

After Biden participated in a wreath-placing ceremony in Shanksville, he commented at a local fire station, discussing the importance of memorials, and praising the passengers and crew of Flight 93 for their courage.

“These memorials are really important. But they’re also incredibly difficult for the people affected by them, because it brings back the moment they got the phone call, it brings back the instant they got the news, no matter how years go by,” Biden said, according to the White House travel pool reporter Saturday.

“It’s one thing to say, ‘I know I should step up.’ It’s another thing to do it. That’s genuine heroism,” Biden reportedly said of the Flight 93 passengers and crew.

Biden lauded George W. Bush’s speech at the Shanksville memorial ceremony today, where the former president slammed political divisiveness and called for unity. Biden noted that he took pictures at the firehouse with boys who were sporting Trump hats.

“Are we going to, in the next four, five, six, ten years, demonstrate that democracies can work, or not?”

When asked about how national unity could return, Biden said that honesty would help achieve that goal, and stated that there would be “no hiding the ball” from him, the pooler reported.

Deena Burnett Bailey, whose husband, Tom Burnett, was killed on Flight 93, said they spoke at least three times on the phone when he was on the plane. Bailey said that his final words to her described the passengers and crew’s plans to fight the hijackers.

“He started sharing the information I was giving him to the people around him. He just sounded very matter-of-fact, like he was just gathering the information and trying to sort it out,” Bailey told CNN. “He called again a third time and he told me that he put a plan together to take back the airplane. They were waiting until they were over a rural area to take back the cockpit. He said not to worry.”

“He was a little concerned in the last phone call but he also was very confident, he was very capable. He seemed that he was very, very much in charge of the situation and going to make a difference. I believed him when he said everything would be OK. Then his final words to me were ‘don’t worry, we’re going to do something.’ He hung up the phone, they went up the aisle and into the cockpit,” Bailey recalled.

Bailey also told CNN that today’s ceremony is different than in prior years, since her three daughters are now all adults.

“Even though that’s a very big milestone, for me, this is the first year all of my girls are educated, out of school and are grown, working, living on their own, living out of state,” she said to CNN. “As a mom who was so incredibly concerned 20 years ago about how I was going to raise these three babies on my own financially, emotionally, mentally, how I was going to do that, this is really the first anniversary in which I have been able to say I did it. I did it.”

Bailey reportedly said this is the first time all three of her daughters have attended the memorial. Bailey’s twins were just five years old, and her youngest three years old, when Burnett died.

Earlier today, Queen Elizabeth II sent a message to Joe Biden to commemorate the 20th anniversary of 9/11.

“As we mark the 20th anniversary of the terrible attacks on September 11 2001, my thoughts and prayers – and those of my family and the entire nation – remain with the victims, survivors and families affected, as well as the first responders and rescue workers called to duty,” the message said.

“My visit to the site of the World Trade Center in 2010 is held fast in my memory. It reminds me that as we honour those from many nations, faiths and backgrounds who lost their lives, we also pay tribute to the resilience and determination of the communities who joined together to rebuild.”

The Guardian’s David Smith has the full report on today’s commemorations so far:

Some wept. Some held photos of loved ones. At 8:46am, precisely two decades after a passenger plane became a new and deadly weapon here, all fell silent in remembrance.

Families of the victims gathered at the 9/11 memorial plaza in New York on Saturday to mark the 20th anniversary of terrorist attacks that killed nearly 3,000 people and helped shape the 21st century.

The sombre ceremony in bright sunshine that was eerily reminiscent of the morning of 11 September 2001 was attended by Joe Biden and former presidents Bill Clinton and Barack Obama along with victims’ families and first responders. Many wore face masks because of the coronavirus pandemic.

Biden had hoped that the milestone anniversary could provide a much-needed moment of national unity after ending the war in Afghanistan, launched to root out al-Qaida, which carried out the attacks. But anger is still raw over the the chaotic withdrawal and return to power of the Taliban.

Read the full article here:

Joe Biden and Jill Biden are now in Shanksville, Pennsylvania, at the Flight 93 memorial. Biden was in New York City this morning for the memorial ceremony at Ground Zero. He and First Lady Jill Biden are scheduled to travel to the Pentagon later today.

In Downtown Manhattan, Sarah Routley told The Guardian’s Edward Helmore about being in class when she learned that the Twin Towers had been attacked.

“I was a fashion student at the time, and we were in class. The supervisor came in and told us the building was being evacuated,” Routley says. “People were leaving the city...military with machine guns. I couldn’t believe it. They used it as justification for a war, and shifted the course of history.”

“For me, personally, it made me question what was I doing in life. It was hard for anyone who didn’t have a super-serious job, who did anything at all frivolous,” she said. “I went to give blood that day, because we thought there might be survivors who needed help. They said, no, we don’t need your blood. There’s no one to give it to. There are no survivors.”

“The whole idea was unbelievable, and the dust in the air... we were literally breathing in the people who died. It’s shocking.”

“At the time, my boyfriend was a Muslim guy. It was hard for him, like it is for Asian people now. He was afraid to go out,” she said. “Today, it’s still sad, but I think the world has been resilient in a lot of ways. We can take comfort in the resilience of New Yorkers and Americans in general, I think.”

As America’s leaders call for unity on this somber day, Donald Trump, one of the most divisive presidents in US history, notably did not join other presidents at today’s ceremony in New York.

Trump was not at the Ground Zero memorial this morning. He is expected to visit at some point today. During a Fox News interview Friday, Trump said that he would be going to Manhattan. Trump is from New York City.

Tonight, Trump is scheduled to give ringside commentary at a boxing event in South Florida, which will be headlined by Evander Holyfield, the 58-year-old former heavyweight champion, the Associated Press reports. Donald Trump Jr., the ex-president’s son, will join him. The pay-per-view event, which costs $49.99, will be on FITE.TV.

“I love great fighters and great fights. I look forward to seeing both this Saturday night and sharing my thoughts ringside. You won’t want to miss this special event,” the AP quoted Trump as saying.

George Bush, now speaking at the Shanksville memorial, said “there was horror at the scale of destruction” on 9/11.

“There was shock at the audacity of the evil,” he remarked, “and gratitude at the heroism and decency that opposed it.”

“The actions of an enemy revealed the spirit of the people, and we were proud of our wounded nation.”

Bush praised the passengers and crew of Flight 93, saying “here, the intended targets became the instruments of rescue” and that many who are alive today owe their lives to them.

Gordon Felt, president of the Families of Flight 93, has addressed the memorial ceremony in Shanksville.

Felt’s brother, Edward, was on Flight 93. Passengers and crew on Flight 93 fought back against the hijackers, and it is believed their actions prevented the terrorists from crashing the plane into the US Capitol.

“Having lost a brother on September 11, I too live with the grief that is deep, consuming, and always present. For those that lost loved ones in the terrorist attacks on our country 20 years ago today, you know that we can never move on — but that we must continue to move forward,” he said.

Felt said: “There are still many questions to be answered about that day, facts to be declassified and released”, as well as justice to be done. He said that the victims, who were mostly strangers, “found the courage to band together at a moment’s notice” without regard to their political, religious, and cultural differences.

Under these extreme conditions, they “were able to change the course of history” so that the final image of 9/11 would not be an attack on the Capitol, which would have been “The greatest symbol of our democracy in ruins.”

Vice-President Kamala Harris is in Shanksville, Pennsylvania, at the memorial ceremony remembering the victims of Flight 93. At 10.03am on September 11 2001, Flight 93 crashed into a field near this small town.

The crew and passengers of this flight fought back against the hijackers. Their heroism is thought to have prevented the hijackers from crashing the plane into the US Capitol.

George Bush, who was US president on 9/11, is also present in Shanksville. Harris is expected to be the keynote speaker. Bush is also expected to give remarks.

The US Secretary of Defense, Lloyd Austin, spoke at the Pentagon memorial ceremony, where he expressed his condolences and said that America must be “tireless” in protecting its values of liberties, rights, and the rule of law.

“On behalf of the Department of Defense, let me renew our deepest condolences to the families and loved ones of all those lost on 9/11, including the 184 souls taken from us in the attack on the Pentagon, in the building, and on Flight 77. We know that you carry pain every day. We know that you bear your losses—not just at times of ceremony, but also in ordinary moments of absence, in quiet minutes that can seem to stretch on for hours,” Austin said. “All of us are here because we remember, and I hope knowing that is at least some measure of comfort.”

“We know that the memories can be hard to bear. We know the sorrow doesn’t end. But over the years, we hope, that the good memories come to us more often and more easily. And today, we remember not just who our fallen teammates were, we remember the mission that they shared, and we recall their common commitment to defend our republic and to squarely face new dangers,” Austin also said.

Austin later remarked that “as years march on, we must ensure that all our fellow Americans know and understand what happened here on 9/11, and in Manhattan, and in Shanksville Pennsylvania. It is our responsibility to remember, and it is our duty to defend democracy.”

“We cannot know what the next 20 years will bring. We cannot know what new dangers they will carry. We cannot foresee what Churchill called the ‘originality of malice,’ but we do know that America will always lead and we do know the only compass that can guide is through the storms ahead, it is our court values and the principles enshrined in our Constitution—liberty, rights, the rule of law, and the fierce commitment to a government of the people, by the people, and for the people.”

“It is our job to defend the great experiment that is America, to protect this exceptional republic, body and soul, and to defend the American people in our democracy even when it’s hard, especially when it’s hard,” Austin also said. “Ladies and gentlemen, we must be tireless guardians of our ideals as well as our security because we cannot have one without the other.”

Barbara Lee, who was working at the Pentagon on 9/11, was among those who attended a private memorial there.

“I think it’s appropriate that we remember, we remember the people that we lost, we remember the families,” Lee told USA Today. “It’s just kind of sad day.”

Richard Keller and his wife attended the Pentagon memorial ceremony to honor his son, Chandler Keller. The 29-year-old, who was on American Airlines Flight 77, which left Dulles airport for Los Angeles, was killed on this flight.

“We lost him on that day, and we’ve been back almost every year to remember him,” Keller told USA Today. “We’ve had the blessing of a wonderful family and friends that have kept us whole throughout all this.”

Keller also remarked: “We just can’t believe it’s been 20 years. “We’re tried hard to keep his memory alive.”

Abdelalim Abdelbaky’s grandfather operated a food stand near Ground Zero. He was working on September 11 and witnessed the attacks.

“My grandfather was here that day. He couldn’t believe what he saw. It affected everyone—Muslims, Christians, Jewish. Everybody cried that day,” Abdelbaky told The Guardian’s Edward Helmore.

“He said to me he said his customers from the towers were good people. He couldn’t believe that they were lost,” he continued. “That’s why I love to keep my cart next to Ground Zero, in his name.”

Thea Trinidad, whose father was killed during the 9/11 attacks, signed up to read the victims’ names during today’s ceremony. Trinidad was just 10-years-old when he was killed.

“It’s hard because you hoped that this would just be a different time and a different world. But sometimes history starts to repeat itself and not in the best of ways,” Trinidad told the Associated Press.

She overheard her father, Michael, telling her mother goodbye over the phone, calling her from the World Trade Center. Trinidad told AP that while she recalls the pain, she also remembered how the city came together and New York “felt like it was family.”

“Now, when I feel like the world is so divided, I just wish that we can go back to that,” Trinidad also commented. “I feel like it would have been such a different world if we had just been able to hang on to that feeling.”

Bruce Springsteen has performed the song, “I’ll see you in my dreams” during the 9/11 memorial ceremony at Ground Zero. The names of victims are being read.

Edward Helmore has spoken with Ken Corrigan, 54, a firefighter working at Ground Zero on 9/11.

“Like every year, it’s hurtful. I lost friends in the fire department, in the police department, the guys who went over to Iraq and Afghanistan. When we left our firehouse in the Bronx to race down here, we were told a second aircraft had hit and all units were driving into a war,” Corrigan said.

“A lot of my guys didn’t understand what that meant. They asked me what does that mean? They couldn’t fathom what we were going into. I said, somebody declared war on us,” Corrigan continued. “We were told that people were trapped in the towers. To this day, I look up for those towers. To see the way the sky is today, 20 years ago, same thing. It scares me. Scares the living daylights out of me.”

“To not know if you were going to live or die when those towers came down is something that never leaves you. I’m a survivor of the World Trade Center—twice,” he recalled. “We were in subway station when they collapsed and we’re able to find our way out. Thank God, none of my guys died, but our rig got crushed.”

Former President Bill Clinton and 2016 democratic presidential candidate Hillary Clinton are also present at Ground Zero, where the 9/11 memorial ceremony will begin momentarily. They join the Bidens and Obamas.

The Guardian’s Edward Helmore is in Downtown Manhattan, where the memorial ceremony will soon begin at Ground Zero.

Helmore reports:

The streets of lower Manhattan were sealed off Saturday, the sky as clear as it had been on the day 20 years ago when the terrorist attacks took place.

As firefighters and police, the families of those lost on 9/11, military who had served in the Afghan and Iraq wars, assembled near Ground Zero for the remembrance, there was a pervasive sense of sorrow and respect.

“My feelings today are of sadness,” Sean O’Malley, heading to the memorial to play in the FDNY band. O’Malley, who was off-duty that day and called in to respond, was assembling a team of firefighters when the towers came down.

“It just feels like yesterday. It really does. The loss doesn’t get less, and the pain is certainly still there. It doesn’t lessen with years, you just get to shoulder the burden a little easier. So many wives, lots of families and communities were impacted. So many people who didn’t get to see their children grow up, see them off to college.”

President Joe Biden and First Lady Jill Biden have arrived at Ground Zero for the 9/11 memorial in New York. They will join the families of the victims. Former President Barack Obama will also join them. The ceremony will begin at 8:30 am.

Hello, Guardian readers.

Today marks the 20th anniversary of 11 September 2001. On this somber day, America will grieve for victims of the terrorist attacks on New York City and Washington DC that killed nearly 3,000 people, sparked long, bloody wars in Iraq and Afghanistan and dramatically altered the course of the 21st century.

Twenty years ago, al-Qaida terrorists hijacked four commercial airplanes and steered two of them into the World Trade Center. Victims from across the world were killed in these first explosions. Some jumped to their deaths. Others were killed in the collapse, while millions watched the horrific events unfold on live television.

Al-Qaida terrorists slammed another airplane into the Pentagon, which is the headquarters of the US armed forces near Washington, ripping a hole into the building’s side. The fourth airplane, which may have been destined for the US Capitol, plummeted into a field in Shanksville, Pennsylvania, as passengers heroically fought back against the hijackers.

In total, 2,977 died, with 2,753 victims at Ground Zero in Manhattan. The death toll exceeds fatalities on the “day of infamy” at Pearl Harbor in 1941.

President Joe Biden and the First Lady, Jill Biden, are scheduled to join victims’ families at the three sites where these airlines crashed. Former president Barack Obama will join the Bidens at the 9/11 memorial in New York, at 8.30am. Obama oversaw the killing of Osama bin Laden, the al-Qaida leader, in 2011.

While Biden might have wanted the 20th anniversary of 11 September 2001 to provide even a brief sense of unity across the deeply divided US, sharp criticism over the recent US withdrawal from Afghanistan continues.

Following the tumultuous departure of American forces from Kabul less than two weeks ago, which ended the US’s longest war, the Taliban have regained control of Afghanistan. This has stoked fears that Afghanistan – which was controlled by the Taliban on 9/11 – will once again turn into a safe harbor for terrorists.