Even now, more than seven years later, images of that day remain frightfully raw, in large measure because a legion of photographers and journalists made the unimaginable events of September 11, 2001, all too real. Some happened to be in lower Manhattan when the first plane struck that morning. Some arrived as the first tower collapsed. Others called in favors so they could slip under police barricades or fly over the debris pile while the fires raged. All of them considered themselves lucky to have been able to get so close to the biggest story of their lives.

But their luck also marked them. Being close enough to the tragedy to capture the horror put them close enough to breathe in the dust that exploded with hurricane force from the obliterated towers. Close enough to have the dust work its way into their bodies just as the images of that day worked their way into their minds and hearts.

Several scientific studies have linked the dust—as corrosive as drain cleaner—to a range of medical problems, some chronic and some life-threatening. The tsunami of dust engulfed everyone who was there that day. Some were left with disabilities that curtailed or ended their careers. Some carry physical and emotional scars that they rarely speak about.

Gary Fabiano, a freelance photographer, had been downtown shooting polling booths for what had started out as primary-election day in New York. He was heading back to his agency’s office when a call came in on his cell, and he turned right around. He got so close to the towers that when he looked up, he could not see the top of the building coming down at him. But he heard it. “It was like an avalanche of steel and concrete, the steel snapping, the concrete grinding,” he says. “It went completely black, then dead silent.”

Fabiano and a New York City firefighter tried to outrun the dust cloud. They took shelter in the loading dock of 7 World Trade Center, a building that hours later would also collapse. “There was so much soot and what the fireman told me was pure asbestos in the air we were breathing,” he says. “If you took vacuum bags, filled them up with dust and emptied them down your throat, that’s pretty much what it felt like.”

Besides tons of ground-up concrete, the 9/11 dust clouds contained a toxic brew of compounds—including asbestos, lead, benzene, and mercury—that scientists continue to study. What we know so far is that exposure, even for a relatively short time, could burn breathing passages and cause permanent damage. The dust contaminated lungs and could lead to scarring diseases, like fibrosis and sarcoidosis. While the scientific link between dust and disease has not yet been proven with absolute certainty, the dust has been connected to underweight babies born in lower Manhattan, and to a sharp increase in asthma among adults. And the fallout hasn’t been limited to physical ailments. A high percentage of individuals caught in the dust cloud developed post-traumatic stress.

Of course, ground-zero journalists are not alone in falling victim to the dust. Hundreds of uniformed responders—police and fire and emergency medical technicians—have left their jobs on permanent disability. Thousands of construction workers who cleared the site, most of the time without the protection of any kind of respirator mask, are suing the city because they got sick. And for thousands who lived, worked, or went to school in the shell-shocked neighborhoods of lower Manhattan, the dust infiltrated nearly every inch of their lives.

But what sets journalists apart from the others is that, by and large, they have not been treated like victims, either because of their own denials or because the system does not consider them responders, even though they—like cops and firefighters—rushed toward the doomed buildings as everyone else ran away from them. Some have had to fight with their employers for help, arguing with human-resources officers and compensation lawyers who refused to link illness to dust. Some have simply not told their supervisors they were hurt, fearing that acknowledging an ailment or asking for time off would break a newsroom ethos. “I was astounded to learn that the stigma and shame attached to acknowledging any emotional stress was even greater for journalists than it was for policemen, firefighters, and other emergency responders,” says Elana Newman, a psychologist and director of research for the Dart Center for Journalism & Trauma, which addresses the coverage of tragedies and the impact that such coverage has on journalists. Newman and Dart ran a trauma center for ground-zero journalists in 2002. She says that she spent time talking with a broad range of people who survived the disaster, but found that journalists were the least willing to talk about their feelings. Getting them to come to the formal group sessions she organized proved difficult, so she eventually had to conduct meetings in bars and an East Village photography gallery. “Journalists do see themselves as different,” she says.

Take Bolivar Arellano, a senior photographer for the New York Post who rushed to the World Trade Center on the morning of September 11, arriving in time to photograph people falling a thousand feet to their deaths. When the first tower collapsed, Arellano was directly beneath it and shot pictures of it coming down on top of him. He escaped, but was back by the time the second tower collapsed. This time he was blown off his feet and knocked unconscious. When he came to, his right leg was torn open at the knee. “When I got up I must have had ten pounds of dust on my back,” Arellano says, during a recent interview on the east side of Manhattan, near where he lives. “I thought, ‘I survived the collapse but now I’m going to die by the dust and ash.’ ”

Arellano recovered and went back to work. But he wasn’t the same. He developed a dry cough that never really went away. He lost his balance, and more. “I also started having emotional problems but I was afraid to say anything to the editors,” he says, and that included his son, Juan, the Post’s photo editor. In his native Ecuador, Arellano had covered a massacre of students, and he photographed victims in El Salvador during the war there. But 9/11 had scarred his heart as well as his leg. “I couldn’t tell anyone that I cried day and night thinking of those people jumping,” he says. “They would think that I was an emotionally unstable person.”

Arellano eventually received a monetary settlement from the federal government’s September 11 Victim Compensation Fund for the injury to his leg. His knee healed, but his breathing problems and emotional stress have never gone away. Four years ago, he retired from journalism. “Last week I was coughing like a dog—that same dry cough as always,” Arellano says. “I live with the fear that I’m going to choke and not be able to breathe.” He is sixty-four.

Freelancers have been even more reluctant than staffers like Arellano to admit their troubles to editors and colleagues, certain that turning down an assignment that they are no longer physically capable of doing, or asking for less-stressful assignments, would hurt their careers. “I will never tell them I am sick—never—for the simple reason that I am disposable,” says Philippe Gassot, a fifty-two-year-old freelancer who in 2001 was a correspondent for French TV based in Washington, D.C. On the morning of September 11, he sped up I-95, arriving at ground zero by late afternoon when the air was still opaque with dust and smoke. For the next month, he was at ground zero every day, filming pieces and transmitting them to France.

Gassot flew back to France for Christmas that year, and colleagues there who had seen the huge dust clouds on TV urged him to see a doctor. During the examination, the doctor found that his lung capacity had dropped by 10 percent. Three years later he took a stress test. “The doctor asked me when I had had a heart attack,” Gassot says. He thought the doctor was mistaken. “I was always in good health before; I never had any problems, never saw a doctor. Suddenly, I had all kinds of problems, and they put a stent in my vein.”

Gassot did stories on the ground-zero workers who signed up for screening and monitoring at the Mount Sinai Medical Center’s World Trade Center programs, which are looking after more than 20,000 people who inhaled trade-center dust. But he never enrolled himself because he didn’t want to take a chance of someone finding out about his condition.

A few years ago, New York State changed its workers’ compensation system to help workers who had been injured at ground zero. Typically, a claim must be filed within two years of a work-related injury. But illnesses caused by exposure to contaminants, such as those found in the trade-center dust, may not develop until years later. The legislature enacted special provisions to give people who might not be sick now until 2010 to register for the right to file claims far into the future. Everyone who worked on the rescue and recovery operations at ground zero in 2001 and 2002 was covered by the extended deadline. But not journalists.

That bothered David Handschuh, a forty-nine-year-old New York Daily News photographer who was caught in the debris from the collapsing south tower. His right leg was shattered, and he developed post-traumatic stress that prevents him from shooting hard news even now. He went to the state workers’ compensation board and asked why journalists and photographers were not covered. “They said it was because the legislation does not specifically include members of the media,” Handschuh says.

Joseph Cavalcante, a spokesman for the workers’ compensation board, says that’s true, but that journalists can file the registration form (called a WTC-12) anyway. This way, he says, if the law changes they will be covered. Handschuh acknowledges that getting the legislature to revisit the law and include journalists is a long shot, but he is putting together a case that may end up helping. He has posted a four-page questionnaire on the Web site of the New York Press Photographers Association, asking for specifics about who worked at ground zero, and how doing so has affected them. He has amassed the most comprehensive set of data about photographers and journalists who were injured on 9/11.

So far, 190 media workers have responded. Fifty-seven percent reported having breathing problems after working at ground zero. Nearly 40 percent said they had developed asthma, and half of those who reported having breathing problems said they were still struggling to breathe today. One in three journalists said that the air at ground zero had caused a chronic cough (only 13 percent said they were active smokers and 58 percent said they had never smoked). Nearly 60 percent said they had developed acid reflux, or similar maladies, after 9/11, and most said they still have it. The journalists’ problems were not limited to physical ailments. Nearly one in five said they had been diagnosed with post-traumatic stress disorder, and one in four was suffering from depression.

For some, there was no distance at all between the biggest story of their careers and their own lives. On 9/11, Catherine Leuthold, freelance photographer, took the subway into Manhattan and got there in time to photograph both towers collapsing. At one point, she ducked into an abandoned ambulance, grabbed some gauze and wrapped it around her nose and mouth. “I remember thinking it was really bad to breathe this stuff in.”

Within days, she started having trouble breathing. A runner, she couldn’t even walk briskly for more than a few blocks. Early in 2002, when she was in Hebron to cover the second Intifada, she and a fellow photographer had to run from what sounded like gunfire. She struggled to breathe, and collapsed. Vertigo kept her bedridden for two and a half days. Back in New York months later, she rushed to cover an explosion in Chelsea but ran out of breath so quickly that she knew something had to be wrong. That was followed by another Middle East trip, and the funeral of a Palestinian boy who had been shot by Israeli soldiers. “I was sobbing, and I was taking pictures at the same time, and realizing that I didn’t know if I could continue,” Leuthold says.

Her breathing problems got worse, the vertigo continued, and Leuthold realized that she had been hurt on 9/11 in ways that she was still figuring out. She felt she needed a drastic change, so in 2006 she left New York for a two-hundred-year-old farmhouse on the Maine coast. She is a landscaper there now, designing gardens and planting bulbs. She teaches photography at a local Montessori school and she still shoots, though nothing resembling hard news.

For many who responded to Handschuh’s survey, merely admitting a dust-related ailment raised the fear that it could derail their careers. Thirty percent said that their health problems had affected their careers, and about the same percentage felt that their emotional problems were interfering with their work. And here’s the key to understanding ground zero’s impact on journalists: nearly half of those who responded (45 percent) said they had been tempted to turn down an assignment that might trigger unwanted emotions. Yet only 25 percent said they had actually refused to take the assignment.

Like most 9/11 health surveys, this one suffers from its reliance on self-reported data. The exception is the New York City fire department, where each firefighter undergoes a yearly physical. That makes it possible to compare pre-9/11 and post-9/11 conditions. The results seem to support some of Handschuh’s findings. Fire-department doctors have found, for instance, that many firefighters lost in one year the amount of lung capacity that they might have been expected to lose over the course of a dozen years.

Photographer Keith Silverman is a freelance cameraman with his own video company who worked regularly with 20/20 and other abc network programs. On September 11, he was preparing to shoot the Fashion Week show at Bryant Park; when the first jet smashed into the north tower, a producer sent him to the trade center. Silverman spent that night and most of the following week videoing firefighters pulling bodies from the trade-center rubble. In all, he worked in the smoke and dust for three months without protective gear. Silverman, who is six-feet tall and weighs 260 pounds, says that it wasn’t until 2004 that he first started noticing strange skin rashes on his arms and back. At that time, he was going through a divorce and had lost his health insurance. A friend who is a nurse urged him to see a doctor about the mysterious lumps on his neck and chest. He did, and the tests came back positive for stage 2 Hodgkin’s Lymphoma. He was forty-seven at the time. A subsequent CAT scan revealed that he also had pulmonary fibrosis.

Silverman says he didn’t expect help from ABC because he was a freelancer, and he was right. It was too late for him to file for workers’ compensation in New York. His only option was Social Security disability, but the legal process has been long and grueling. He’s been turned down twice, and is appealing his case to a judge. He’s also joined the thousands of responders who are suing the city of New York for negligence in the aftermath of 9/11.

Silverman could have gotten help from Mount Sinai’s monitoring program, but after he signed up for it, he moved to Atlantic City and never went. At least 113 people who describe themselves as journalists, photographers, or camera operators are among the people enrolled in Mount Sinai’s various 9/11 programs. Dr. Philip J. Landrigan, who oversees the programs, says the journalists are “showing pretty much the same problems at roughly the same proportions as anyone else who was down there.” Those problems include asthma, sinusitis, interstitial lung diseases, acid reflux, and post-traumatic stress.

One of the important findings from Mount Sinai and other studies is that many people who were exposed to the dust in the first few days developed the same complex set of related illnesses. My friend Keith Meyers is one of them. We worked together for more than two decades at The New York Times. He is an avid boater who has covered many stories in and around New York’s harbor. After 9/11, he used his contacts to talk his way aboard a Coast Guard helicopter that flew over ground zero. He was in the air, with his camera out the open door, as the chopper hovered over the burning debris pile in the days immediately after the collapse. The smoke and gasses from the raging fires mixed with the dust and ash from the collapsed towers in ways that scientists believe made breathing that air at that time particularly hazardous. Meyers wore no protective gear, but he came back with prize-winning photographs.

By 2006, Meyers was barely able to work. He had come down with the whole range of trade-center symptoms—the persistent dry cough, recurring asthma, gastrointestinal reflux disease, and emotional distress. Although he had photographed many grisly events in his career, Meyers was unnerved by the images from 9/11 and the lingering physical impact the dust had on him. He was put on restricted duty, but in time, as his physical problems mounted, even that proved too stressful.

His editors and immediate newsroom supervisors were sympathetic and did what they could to help. But when he put in for workers’ comp, he found himself fighting a system set up to handle broken arms, not breathing problems that take years to develop. As I was writing story after story about the environmental and health impact of ground zero, I watched Meyers get sicker and sicker. Because of the articles I was writing, he opened up to me about the hoops he had to jump through as he dealt with corporate medical officers and the Times Company’s insurer, who suggested that his asthma was a preexisting condition even though Meyers had regularly passed the Federal Aviation Administration’s rigorous Class 1 Flight Physical, which allowed him to fly with and photograph the crew of the space shuttle Challenger while they were in training.

Officials at the Times declined to discuss individual personnel issues. But William Schmidt, a deputy managing editor who worked to get help for Meyers, says that dealing with his post-9/11 issues has raised important new considerations for the newsroom. “Whenever we send people into harm’s way, we stand behind them and we always will,” Schmidt says. “But the kinds of problems and risks that were presented at the wtc site were something new to us and were not as easily understood or assessed.” 

After years of emotionally draining struggle, Meyers was put on indefinite medical leave. He said he is satisfied with the way the Times ultimately resolved his case, and he finally won his workers’ compensation case. But winning is a poor way of describing what’s happened to him since 9/11. He can no longer shoot photographs or go out on his beloved boat. He declined several requests to discuss his problems on the record, saying it was too painful. But in a brief interview in March 2008 with the Photo District News, Meyers, who is now sixty, revealed the sad truth about his situation. “Not working is harder than being sick,” he said.

Bruce Shapiro, the executive director of the Dart Center, called 9/11 “a wake-up call for a lot of news organizations.” But with economic gloom hanging over the news industry now, adding the costs of trauma training isn’t a priority.

I’ve spent a lot of time over the last four years interviewing survivors of 9/11, many sick and most full of fear. They told me how the worst thing of all has been dealing with the unending doubt. They feel betrayed whenever insurers or the compensation system or their own bosses question how dust could make anyone sick. Science, medicine, and the courts are searching for certainty before making a definitive link between the dust and disease. But I’ve learned that absolute certainty can be an elusive goal, and that it has different meanings in the laboratory, in the courtroom, and perhaps in the unspoken ethos of the newsroom.

New York State’s decision to allow uniformed responders to register for future claims can be seen as a tacit acknowledgement of the bleak future that possibly awaits those who inhaled the dust. Excluding journalists and photographers from those provisions challenges concepts of fairness and justice. For ground-zero journalists it’s painful, but no surprise. “No one wants to say that yes, this existed, because that opens up the door for anyone who was down there to ask for help,” says Gary Fabiano, the freelance photographer who took refuge at the loading dock on 9/11. He says he feels helpless to change things for himself, or for others. And he knows that no matter what happened before, the next time there’s a catastrophe and the air is poisoned, he’ll be expected to rush in, no questions asked.

And he says he probably will. 

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Anthony Depalma , a reporter and foreign correspondent for The New York Times for more than twenty years, is now writer-in-residence at Seton Hall University. He is writing a book about the aftermath of 9/11.