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The September 11 memorial ceremony in New York will include a new moment of silence this year.
The change reflects a growing toll from illnesses linked to the 2001 attacks.
For years, the annual ceremony at Ground Zero has featured six moments of silence. Each marks a key moment during the attacks.
A bell rings when each of the four hijacked planes crashed. Bells also mark the collapses of the World Trade Center towers.
Families then hear the names of nearly 3,000 people who died on September 11, 2001.
This year, organizers will add a seventh bell and moment of silence.
The new tribute will honour people who died in the years after the attacks from illnesses linked to toxic dust and debris at the World Trade Center site.
The seventh moment will come after the traditional six bells.
The 9/11 Memorial & Museum said the additional bell will ring at about 12:30 p.m.
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Families of people who died after September 11 will take part in the ceremony. Names will continue to be read during the event.
New York Mayor Zohran Mamdani said the additional tribute reflects the continuing human cost of the attacks.
He said more people have now died from 9/11-related illnesses than died on the day itself.
The change comes as New York prepares to mark the 25th anniversary of the attacks.
First responders and survivors faced intense exposure to dust and debris after the towers collapsed.
The health effects have continued for decades.
Cancer, respiratory diseases and post-traumatic stress disorder rank among the conditions linked to 9/11 exposure.
The World Trade Center Health Program provides medical monitoring and treatment for eligible responders and survivors.
The programme began in 2011 after years of campaigning by first responders and survivors.
CDC data shows that more than 57,000 people enrolled in the programme had received cancer diagnoses.
Nearly 7,000 enrolled members had died by March 2024, according to programme data.
The figures highlight the long-term impact of the disaster.
For many families, the seventh moment of silence represents long-awaited recognition.
Leah Betso lost her father, NYPD Officer James Betso, in 2015. He died from brain cancer after spending months working at Ground Zero.
Betso said the new tribute acknowledges families whose losses came years after the attacks.
Other families faced similar experiences.
New York firefighter Billy Gormley spent months working at the World Trade Center site. He later developed bladder cancer and died in 2017.
His daughter Bridget Gormley said her family did not initially discuss the possible health consequences of the exposure.
Over time, she learned more about the illnesses affecting former responders.
Michael O’Connell joined the New York City Fire Department shortly before September 11.
He worked at Ground Zero during the recovery operation.
Years later, he developed sarcoidosis, a disease that can affect the lungs and other organs.
The World Trade Center Health Program has certified his condition, according to O’Connell.
Other responders have reported serious illnesses and lasting injuries.
Ivonne Sanchez worked in emergency medical services during the recovery effort. She suffered injuries at Ground Zero and later developed breast cancer.
Retired NYPD Sgt. Thomas Wilson also worked at Ground Zero and the Fresh Kills landfill.
He has reported several health conditions, including cancer, asthma and PTSD. His conditions have been certified through the health programme, according to his account.
The World Trade Center Health Program continues to provide care.
More than 154,000 people were enrolled as of June, according to programme data.
That figure includes people who have no current illness.
The programme also covers eligible people who were at the Pentagon and those involved in the response near Shanksville, Pennsylvania.
Dr Michael Crane, medical director of a World Trade Center Health Program centre at Mount Sinai, has urged more survivors to seek medical evaluations.
He said many people who lived or worked near the World Trade Center may still qualify for support.
Crane estimates that about 400,000 people who lived or worked around the towers could qualify as survivors.
The 25th anniversary has therefore taken on a wider meaning.
The new seventh moment of silence will remember not only those who died on September 11, but also those whose lives were cut short by its lasting health consequences.
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