REUTERS/Lee Celano   Research support for this article was provided by The Investigative Fund at The Nation Institute and the Puffin Foundation. Additional research by Lindsey Ingraham and Amit Shrivastava.

**Editor’s note: The original story incorrectly stated that Keith Langner went to the emergency room in January 2010—before the BP oil spill. His visit was in January 2011.

  On March 3 Nicole Maurer learned of the proposed settlement between BP and hundreds of thousands of Gulf Coast businesses and residents harmed by its 2010 oil spill, the largest in US history.   In her cramped but immaculate trailer on a muddy back road in the small town of Buras, Louisiana, Nicole tells me that the two years since the tragedy began on April 20, 2010, have been “a total nightmare” for her family. Not only has her husband William’s fishing income all but vanished along with the shrimp he used to catch but the entire family is plagued by persistent health problems.

For months following the onset of the disaster, she says, there was an oil smell outside their home and “a constant cloudiness, like a haze, but it wasn’t fog.” Her 6-year-old daughter Brooklyn’s asthma got worse, and she now has constant upper respiratory infections. “Once it goes away, it comes right back,” Nicole explains.

Before the spill, Elizabeth, 9, was her “well kid.” But now Elizabeth constantly suffers from rashes, allergies, inflamed sinuses, sore throat and an upset stomach.

Nicole stares at me and catches her breath; she apologizes for the tears that flow down her face. “It’s a touchy subject,” she says. “They are just tired. Tired of being sick.”

William worked from June to October 2010 as part of the Vessels of Opportunity program that paid the fishermen BP put out of business to use their boats to clean up its oil. William transported giant bags, called bladders, used to collect oil, to the shore. When he came home at night, says Nicole, his clothes “smelled oily.” Not only were his clothes blackened; so was William.

William’s symptoms began with coughing, then headaches and skin rashes, followed by vomiting and diarrhea. About three to six months later, he started bleeding from his ears and nose and suffering from a heavy cough.

“I ain’t got no money for a doctor,” William quietly tells me, staring down at his hands in his lap. Medicaid covers the kids, but Nicole and William do not have health insurance. “We didn’t know we were gonna get sick. Now I get sick, I stay sick. I don’t sleep. I stay stressed out more than anything. I got bags under my eyes I never had before. I just don’t know if I wanna show people who I am.”

Nicole is fairly confident that the settlement is not going to bring justice. So she wants just one thing: enough money to get her entire family out of the Gulf Coast for good.

Take Action: Help Gulf Residents Reclaim Their Lives

On February 27, US District Court Judge Carl Barbier was to hear opening arguments against BP, Transocean, Halliburton and all the companies involved in the disaster. The case consolidates virtually every civil charge brought against the companies by individuals, business and property owners, and the federal and state governments. It is the most complex and significant environmental litigation in history. As this article goes to press it seems unlikely that the plaintiffs will ever get their day in court. Instead, the judge has issued continuances to allow more time for a series of settlement deals to be negotiated.

As information about the settlement negotiations comes to light, several critical issues are not being adequately addressed—including the human health crisis brought on by the disaster.

Many people whose health was adversely affected by the spill would be excluded. The Medical Benefits Settlement covers about 90,000 people who are qualifying cleanup workers (out of an estimated 140,000) and 110,000 coastal residents living within one-half to one mile of the coast (out of a coastal population of 21 million). Although it would cover “certain respiratory, gastrointestinal, eye, skin and neurophysiological” conditions, it excludes mental health and a host of physical ailments, including cancers, birth defects, developmental disorders and neurological disorders including dementia.

The proposed settlement provides a health outreach program and twenty-one years of health monitoring—but not healthcare. If “nonspecified” ailments occur in this time frame, the patient must sue BP and prove causality to receive a settlement. Accepting the settlement also means forgoing the right to sue BP for punitive damages. BP estimates its total remaining liability for individuals and businesses at $7.8 billion—a lowball figure for many reasons, and much less than would be necessary if large numbers of people do suffer cancers and other chronic diseases as a result of the spill.

Also excluded from any settlement are 194,000 individuals and businesses who accepted one-time final payments from the Gulf Coast Claims Facility (GCCF), which was established by BP on June 16, 2010, to comply with the Oil Pollution Act’s mandate that it fully compensate victims of the spill. Unable to afford to wait out a legal process, 95,000 people accepted payments of $5,000, and 45,000 accepted payments averaging $15,000, agreeing to give up their right to sue BP or any of the companies for any reason, including any harmful health effects. GCCF administrator Kenneth Feinberg was “dubious” about health complaints, as he told the Times-Picayune in September. He went on to question whether cleanup workers suffering from respiratory conditions “are going to be able to provide any support medically or occupationally for the proposition that they’re entitled to get paid. We’ll see.” In the end, except for claims from those injured on the Deepwater Horizon, the GCCF did not honor a single request for compensation related to health concerns.

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In August 2011 the Government Accountability Project (GAP) began its investigation of the public health threats associated with the oil spill cleanup, the results of which will be released this summer. “Over twenty-five whistleblowers in our investigation have reported the worst public health tragedies of any investigation in GAP’s thirty-five-year history,” Shanna Devine, GAP legislative campaign coordinator, told me.

Witnesses reported a host of ailments, including eye, nose and throat irritation; respiratory problems; blood in urine, vomit and rectal bleeding; seizures; nausea and violent vomiting episodes that last for hours; skin irritation, burning and lesions; short-term memory loss and confusion; liver and kidney damage; central nervous system effects and nervous system damage; hypertension; and miscarriages.

Cleanup workers reported being threatened with termination when they requested respirators, because it would “look bad in media coverage,” or they were told that respirators were not necessary because the chemical dispersant Corexit was “as safe as Dawn dishwashing soap.” Cleanup workers and residents reported being directly sprayed with Corexit, resulting in skin lesions and blurred eyesight. Many noted that when they left the Gulf, their symptoms subsided, only to recur when they returned.

According to the health departments of Louisiana, Mississippi and Alabama, from June to September 2010, when they stopped keeping track, more than 700 people sought health services with complaints “believed to be related to exposure to pollutants from the oil spill.” But this is likely an extreme undercount, as most people did not know to report their symptoms as related to the oil spill, nor did their physicians ask. Like virtually everyone I have interviewed on the Gulf Coast over the past two years—including dozens for this article—Nicole Maurer’s doctors did not even inquire about her children’s exposure to oil or Corexit.

It will take years to determine the actual number of affected people. The National Institute of Environmental Health Sciences (NIEHS), with financial support from BP, is conducting several multiyear health impact studies, which are only just getting under way. I spoke with all but one of the studies’ national and Gulf Coast directors. “People were getting misdiagnosed for sure,” says Dr. Edward Trapido, director of two NIEHS studies on women’s and children’s health and associate dean for research at the Louisiana State University School of Public Health. “Most doctors simply didn’t know what questions to ask or what to look for.” There are only two board-certified occupational physicians in Louisiana, according to Trapido, and only one also board-certified as a toxicologist: Dr. James Diaz, director of the Environmental and Occupa-tional Health Sciences Program at Louisiana State University.

Diaz calls the BP spill a toxic “gumbo of chemicals” to which the people, places and wildlife of the Gulf continue to be exposed.

BP released one Exxon Valdez–sized oil spill every three to four days for the eighty-seven days it took to cap the well, for an estimated total of 210 million gallons, plus 500,000 tons of natural gas. It applied some 2 million gallons of Corexit from the air and water. It also conducted about 410 “controlled burns” of the oil on the surface of the water. The spill polluted the air with particulate matter and a visible haze, and polluted the water, exposing Gulf seafood to a host of harmful toxins.

The federal government determined that Gulf residents and response workers were exposed to hazardous chemicals, but has tentatively claimed that only response workers were at risk for chronic health problems. One purpose of the NIEHS studies, however, is to monitor Gulf residents for chronic symptoms. The Centers for Disease Control reported in August 2010 that “the samples collected in places where non-response workers would spend time showed none of those substances at levels high enough to cause long-term health effects.” But the CDC didn’t consider the chemical dispersants. There are other problems with the government’s analyses. As the Louisiana Bucket Brigade has noted, the Environmental Protection Agency pronounced Gulf air quality normal without having data from past years to back up its claim; reported daily averages even though pollutants and chemicals typically came in concentrated bursts, often carried by the wind; lacked sufficient monitoring capabilities to cover affected coastal areas; and was not monitoring for all the most harmful chemicals. As microbiologist and toxicologist Wilma Subra explains, although the EPA identified asphaltenes as a cause of health problems, it did not sample for their presence.

* * *

Writing in the American Journal of Disaster Medicine, Dr. Diaz observed that the ailments appearing among Gulf response workers and residents mirrored those reported after previous oil spills, including the Exxon Valdez spill, and warned that chronic adverse health effects, including cancers, liver and kidney disease, mental health disorders, birth defects and developmental disorders—a list that is repeated by several of the NIEHS study physicians—should be anticipated among sensitive populations and those most heavily exposed. In an interview, Diaz added that neurological disorders should also be anticipated.

Moreover, John Howard, director of the National Institute for Occupational Safety and Health, told Congress, “Previous oil spill response efforts have reported acute and chronic health effects in response workers. These studies may underestimate the health effects associated with oil response work since the magnitude and duration of the Deepwater Horizon response is unprecedented.”

All emphasize the need for additional research, as there is a shocking dearth of long-term studies on the impact of oil spills. It is difficult to get funding for this work, while many experts in the field are employed by the oil industry. When data are acquired, they are often “lost” to litigation culminating in settlements with nondisclosure agreements.

It is known, however, that crude oil is toxic to humans, plants and wildlife, capable of causing serious debilitation and even death, depending on the amount and duration of exposure. Crude oil contains high levels of volatile organic compounds (VOCs), including known carcinogens and chemicals affecting the central nervous system.

Crude oil contains polycyclic aromatic hydrocarbons (PAHs), a group of more than 100 chemicals that are highly toxic and tend to persist in the environment for long periods. PAHs, some of which are human carcinogens, can bioaccumulate up the food chain (i.e., the toxins stored in the body of an organism are passed along when the body is consumed by a larger organism). Like VOCs, they target the skin, eyes, ears, nose, throat and lungs. But the EPA was not sampling for PAHs in the air until the very end of the spill.

Then there’s Corexit, two types of which were used in the Gulf: Corexit 9527A and 9500. The first type contains 2-BTE (2-butoxyethanol), a toxic solvent that can injure red blood cells (hemolysis), the kidneys and the liver. The CDC has reported chronic and acute health hazards associated with it. Corexit 9500 contains propylene glycol, which can be toxic to people and is a known animal carcinogen. Both can bioaccumulate up the food chain. Toxipedia Consulting Services, a moderated wiki run by the Institute of Neurotoxicology and Neurological Disorders, has found “reports among Gulf residents and cleanup workers of breathing problems, coughing, headaches, memory loss, fatigue, rashes, and gastrointestinal problems [that] match the symptoms of blood toxicity, neurotoxicity, adverse effects on the nervous and respiratory system, and skin irritation associated with exposure to the chemicals found in Corexit.”

Gulf residents typically consume more seafood, and in a wider variety, than most Americans do, putting them at greater risk from seafood exposed to oil and Corexit. Children, women who are or may become pregnant, and subsistence fishers who eat much of what they catch are at greatest risk, explains Dr. Cornelis Elferink of the University of Texas Medical Branch, who is conducting the NIEHS study on seafood safety. He tells me that areas of concern include developmental issues for fetuses and children, as well as cellular toxicity and cancer.

The danger posed by all these chemicals depends on three factors: health status, length of exposure and amount of exposure. Children, pregnant women, the elderly and the infirm are the most susceptible. Tourists, coastal residents and response workers were exposed in increasing degrees. Combine these factors—such as children living on the coast, coastal residents with pre-existing health conditions and coastal residents employed as cleanup workers—and you get the most severe effects.

* * *

Charles Taylor, 39, a refrigeration technician, describes living in his Bay Saint Louis, Mississippi, home, a half-mile from the beach, as like “living next to a truck stop” for months after the oil spill. There was “an overbearing smell of almost like a diesel smell mixed with a chemical smell.” Charles was prescribed a nebulizer in the wake of the spill, which he began taking to work with him every day until he lost his job of ten years because of his failing health. He’d have bouts of sickness, and was repeatedly diagnosed with pneumonia and treated with antibiotics. It would take three to four weeks to improve, and then he’d get sick again.

Charles believes that his exposure to oil and Corexit inflamed his Crohn’s disease, which had been in remission for more than twenty years. Within a few weeks of the disaster, he began to have bloody diarrhea. “I couldn’t work. The last two years here for me have been something right out of a sci-fi horror movie. Except that it was real and it happened to me,” he says.

“Oh, sorry, I just had a BP moment,” Steve Kolian tells me. He’s trying to recount the events of last year and trails off, forgetting what he’s talking about. Such bouts of memory loss are common among those I interviewed and are reported consistently across the Gulf. Steve and his Ecorigs co-workers conducted several dives to study corals and collect water samples for the National Oceanic and Atmospheric Administration after the spill. Collectively, they have experienced “blood in our stool, bleeding from the nose and eyes, nausea, diarrhea, stomach cramps and dizziness and confusion.”

Like Kolian, diver Scott Porter has a persistent dermatitis condition, among other ailments. Scott tells me it has a nickname in the Gulf: “the BP rash.”

Cleaning and caring for the beautiful beaches of South Walton, Florida, was Keith Langner’s dream job. His wife, Andrea, tells me that she can count on one hand the number of times he had missed a day of work in seven years. Her 6-foot-2, 300-pound, 50-year-old husband was always “healthy, independent and vibrant.” After the oil spill, “It was just a total disaster on the beach,” Andrea explains. Without special training, Keith was told to try to avoid the oil and do his job. “He tried, but he said it was next to impossible not to touch the stuff,” Andrea says. “If a chair has oil on it, it’s his job to pick it up. He had to empty hundreds of garbage bags up on the beach, in the bathroom; he couldn’t touch anything without getting exposure to this stuff.”

Keith came home with his work clothes covered with oil. “Everything would be covered in brown pooplike stuff.”

Keith went to the emergency room in January 2011 with a terrible headache he could not shake [**Editor’s note: The original story incorrectly stated that Mr. Langner went to the emergency room in January 2010—before the BP oil spill. His visit was in 2011.] . He has since been diagnosed with multi-infarct dementia, which commonly affects people ages 55 to 75. Keith’s dementia began at 49, as his brain was deteriorating. Today, Keith sleeps about three-quarters of the day. The rest of the time he is all but unaware of his surroundings and his behavior. He is physically violent and sexually inappropriate with his wife. His children, ages 7, 9 and 20, are afraid of him. He cannot be trusted in public, with car keys or even to feed himself. His life expectancy is now, according to his wife, about five years.

The most toxic chemicals found in oil are lipid-soluble, which means that they accumulate in organs that contain a lot of fat, like the brain. Consequently, those with the greatest exposure “can get permanent brain damage, dementia, as a result,” Dr. Diaz explains.

Kindra and George Arnesen lived with their three children in Venice, Louisiana. The family has suffered debilitating health effects. When I ask Kindra her ethnicity, she replies, “I’m a Bayou girl!” Nonetheless, the Arnesens decided to leave. “Why am I moving?” Kindra asks me, incredulous. “I don’t want my children to be the energy sacrifice for our nation. How could I? Damn shame on me if I do.”

But Kindra is also not staying silent. As part of Gulf Change, Kindra has helped organize regular protests to raise awareness of the health crisis. On February 29 members hosted a “funeral for the Gulf,” with a procession from BP’s downtown New Orleans offices to Judge Barbier’s courthouse. They are supported by the Louisiana Bucket Brigade, Gulf Restoration Network, and Louisiana Environmental Action Network, among other groups.

Darla Rooks began captaining her own fishing boat at age 8, “just me, my dog and my gun.” Dressed all in black, she walks at the back of the procession, unable to keep up because of the numbness in her leg. It is among several ailments she has experienced since the disaster. High above her head she holds up a giant green sign that says, We Are the World’s Largest Scientific Experiment and We Demand Justice.

Take Action: Help Gulf Residents Reclaim Their Lives