
Common household plastics linked to thousands of global deaths from heart disease, study finds
CNN —
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Synthetic chemicals called phthalates, found in consumer products such as food storage containers, shampoo, makeup, perfume and children's toys, may have contributed to more than 10% of all global mortality from heart disease in 2018 among men and women ages 55 through 64, a new study found.
'Phthalates contribute to inflammation and systemic inflammation in the coronary arteries, which can accelerate existing disease and lead to acute events including mortality,' said senior author Dr. Leonardo Trasande, a professor of pediatrics and population health at New York University's Grossman School of Medicine. He also is director of NYU Langone's Division of Environmental Pediatrics and Center for the Investigation of Environmental Hazards.
'Phthalates are known to disrupt testosterone,' Trasande said, adding that in men, 'low testosterone is a predictor of adult cardiovascular disease.'
Phthalates have been linked in earlier studies with reproductive problems, such as genital malformations and undescended testes in baby boys and lower sperm counts and testosterone levels in adult males. Studies have also linked phthalates to asthma, childhood obesity and cancer.
'The new study underscores the potentially enormous health and economic burden of DEHP exposure, which aligns with existing concerns about its risks,' said David Andrews, acting chief science officer at the Environmental Working Group, a consumer organization that monitors exposure to phthalates and other chemicals in plastics, in an email. He was not involved with the study.
The American Chemistry Council, which represents industry, declined to comment on the study but told CNN via email that the organization's High Phthalates Panel is dedicated to promoting the benefits of high phthalates such as DINP and DIDP.
Phthalates exposure and risk
Often called 'everywhere chemicals' because they are so common, phthalates are added to consumer products such as PVC plumbing pipes, vinyl flooring, rain- and stain-resistant products, medical tubing, garden hoses and some children's toys to make the plastic more flexible and harder to break.
Other common exposures come from the use of phthalates in food packaging, detergents, clothing, furniture and automotive plastics. Phthalates are also added to personal care items such as shampoo, soap, hair spray and cosmetics to make fragrances last longer.
People are exposed when they breathe contaminated air or eat or drink foods that come into contact with the plastic, according to the US Centers for Disease Control and Prevention.
A global study
The new study, published Tuesday in the journal eBiomedicine, examined the impact of one phthalate — Di(2-ethylhexyl)phthalate, or DEHP — on global deaths across 200 countries and territories.
Researchers analyzed health and environmental data from dozens of population surveys, which included urine samples containing chemical breakdown products left by DEHP, which is known to be connected to cardiovascular disease, Trasande said.
Di(2-ethylhexyl)phthalate has also been linked to birth defects, cancer and reproductive harm for men, according to California's Proposition 65, a law that requires companies to place warning labels on products notifying consumers about chemicals' possible health effects.
Researchers compared the exposure with death statistics collected by the Institute for Health Metrics and Evaluation, a US research group that gathers global medical information.
The analysis found exposure to DEHP contributed to 368,764 deaths in 2018 among men and women ages 55 through 64 globally. Africa accounted for 30% of the deaths from heart disease linked to DEHP, while East Asia and the Middle East accounted for 25% of the mortality, the study found.
The research is believed to be the first global estimate of any health outcome from exposure to the DEHP, said lead study author Sara Hyman, an associate research scientist at NYU Grossman School of Medicine.
'By highlighting the connection between phthalates and a leading cause of death across the world, our findings add to the vast body of evidence that these chemicals present a tremendous danger to human health,' Hyman said in a statement.
A limitation of the research, however, stems from the use of hazard ratios the US to estimate population-attributable deaths in other countries, EWG's Andrews said.
'While the authors acknowledge this limitation, it assumes that the relationship between DEHP exposure and cardiovascular disease is consistent globally,' he said in an email. 'This may not hold true given significant differences in both exposure levels and access to CVD detection and treatment across countries.'
An earlier phthalates study analyzed US data
Previous research by Trasande and his team measured the urine concentration of phthalates in more than 5,000 adults in the United States and compared those levels with the risk of early death over an average of 10 years.
In that study, the researchers found phthalates may contribute to some 91,000 to 107,000 premature deaths a year among Americans ages 55 to 64. People with the highest levels of phthalates had a greater risk of death from any cause, especially cardiovascular mortality, according to the study.
The results held even after researchers controlled for preexisting heart disease, diabetes, cancer and other common conditions, poor eating habits, physical activity and body mass, and levels of other known hormone disruptors such as bisphenol A or BPA.
Researchers estimated those deaths could cost the United States about $40 billion to $47 billion each year in lost economic productivity.
Pack your food in metal, ceramic or glass containers, experts suggest, and never microwave food in plastic.
Westend61/Getty Images
How to limit your exposure
It is possible to minimize your exposure to phthalates and other endocrine disruptors, experts say.
'Avoid plastics as much as you can. Reducing your use of ultraprocessed foods can reduce the levels of the chemical exposures you come in contact with,' Trasande said. 'Never put plastic containers in the microwave or dishwasher, where the heat can break down the linings so they might be absorbed more readily.'
Here are other tips to reduce exposure:
· Use unscented lotions and laundry detergents.
· Use cleaning supplies without scents.
· Use glass, stainless steel, ceramic or wood to hold and store foods.
· Buy fresh or frozen fruits and vegetables instead of canned and processed versions.
· Encourage frequent handwashing to remove chemicals from hands.
· Avoid air fresheners and all plastics labeled as No. 3, No. 6 and No. 7.

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Egypt Independent
a day ago
- Egypt Independent
Trump's tariff threat exposes China's tight grip on the global pharmaceuticals industry
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Last year, 96 percent of US imports of hydrocortisone (the active ingredient in the anti-itch cream), 90 percent of imports of ibuprofen (found in common over-the-counter pain relievers), and 73 percent of imports of acetaminophen (in other kinds of pain relievers) all came from China, according to CNN calculations based on trade data from the Census Bureau. With the US already facing shortages of many essential medications, experts warn that Beijing could potentially exploit this reliance as leverage in an escalating trade war. Tensions between the two sides have soared since Trump unleashed his trade assault on the world's second-largest economy. While the two countries have announced a temporary truce that rolled back the three-digit tariffs for 90 days, relations remain tense with ongoing feuding over chip restrictions imposed by the US. Leland Miller, a commissioner at the US-China Economic and Security Review Commission, said the 'chokepoints' that China holds over the US pharmaceutical supply are 'detrimental to American security.' 'Simply by having this leverage … whether or not they ever pull the trigger, causes us to change our policy positions on a lot of things, and that's not good,' he said. So far, China has made no official public threat about weaponizing its dominant position in this segment of the pharmaceutical industry. But Trump's tariffs on the sector, if imposed, could worsen existing drug shortages and drive up prices for Americans, undermining his promise to lower health care costs. Generic drugs, which are designed to provide the same therapeutic effects as brand-name ones and are released after their patents expire, account for 90 percent of all prescriptions in the US. India produces many of those generics, often from ingredients imported from China. Even though industry insiders and experts widely acknowledge America's heavy reliance on Chinese pharmaceuticals, there is little comprehensive data on the full extent of this dependence across the sector, as major pharmaceutical firms have little incentive to disclose such information. That's part of the reason why last month, the Trump administration launched a probe into pharmaceuticals imports as part of efforts to impose tariffs on the sector on national security grounds. A 'catastrophic' interruption With China making 80 percent of the world's raw materials for amoxicillin, according to Jackson, it's a clear example of just how vulnerable the world could be to 'Chinese political or economic whims.' 'Any interruption by China along the lengthy amoxicillin supply chain could be catastrophic, particularly in the face of a potential bacterial epidemic,' he said. In 2021, Jackson purchased a bankrupt manufacturing site located in Bristol, Tennessee, and renamed it USAntibiotics. The facility, built in the 1970s, used to produce enough amoxicillin for the whole country at the time. After the amoxicillin patent expired in 2002, the Tennessee facility began to make generic equivalents. At that point, it began facing lower-cost competition from overseas and eventually went bankrupt. Concerns about America's dependence on Chinese pharmaceuticals aren't new. As early as 2019, the US-China Economic and Security Review Commission recommended that Congress assess America's pharmaceutical vulnerabilities. Two years later, when Jackson bought the amoxicillin factory, he cited national security and the need to ensure a steady supply of antibiotics as a major reason for the purchase. China controls 80 percent of the raw materials required for amoxicillin's production. Fred Tanneau/AFP/Getty Images Still, progress in growing America's pharma supply chain has been slow. In late April, Trump said pharmaceutical companies were 'going to have to' produce drugs in the US or face a 'tariff wall.' A key goal behind Trump's threats of pharmaceutical tariffs is to 'onshore' drug production. An American study in 2021 found that the US imports 72 percent of its essential medicines. But experts said tariffs are unlikely to achieve that goal for generics, which have become commodities, with price being the main differentiator. So-called brand-name drugs, by contrast, are protected by patents and therefore command higher prices and bigger profit margins. Instead, tariffs would not only drive up medical costs for patients, but they could also exacerbate ongoing drug shortages by pushing generic drug makers out of the American market. Even if they are willing to build drug-making facilities in the US, the process could take years. Reliance on China China's dominance in the global drug supply chain is part and parcel of its position as the world's factory. Over decades, the pursuit of lower production costs has prompted drug makers to shift production from Western countries to places like China and India. China plays an outsize role in the drug supply chain for its significant production of the critical chemical compounds, called key starting materials or KSM, which are necessary to produce active ingredients, called active pharmaceuticals ingredients or API. China and India dominate the global manufacturing capacity for API. Together, they account for 82 percent of all API manufacturer filings to the US Food and Drug Administration, according to United States Pharmacopeia (USP), a nonprofit that sets official quality standards for medicines. The filings contain detailed information about the facilities and manufacturing processes submitted by API manufacturers. In the two years after 2021, according to the most recent data, India's share of the filings dropped to 50 percent, while China's surged to 32 percent. Chinese manufacturers have also benefited from Beijing's policy incentives and subsidies for the pharmaceutical sector since the early 2000s, which led to industry clusters springing up in the country, said Qingpeng Zhang, an associate professor at the University of Hong Kong's LKS Faculty of Medicine. 'These industry clusters, which help drive down overall costs while maintaining quality … ultimately made China an ideal location for the production of generics and APIs within a free trade environment,' he said. Besides lower costs, the environmental impact of drug production also contributed to China's rise in this sector, as the US and European Union often have stricter environmental regulation, according to Ronald Piervincenzi, CEO of USP. Even India, the world's top supplier of generics, relies on China for APIs and other key ingredients. In fact, 70 percent of India's API imports come from China, according to a 2023 report commissioned by the Indian government. Dinesh Thakur, a public health expert and author of 'The Truth Pill,' a book on Indian drug regulations, said that India's reliance on China for drug materials reflected the 'natural evolution' of the industry. At the time when Indian drug companies moved up the value chain toward higher-margin products like formulations and injectables, China's nascent pharmaceutical sector made inroads with API production at a lower price point, he said. The Indian companies then 'bought the API for a lesser cost from China and focused their money and their capacity in India on building competence for developing more complex finished formulations,' Thakur said. He added that China's well-established chemicals industry, built independently of pharmaceuticals, also gave its manufacturers a head start in producing drug-related chemicals. Major policy push Besides its cost advantage, China's pharmaceutical industry also got a boost from the government. In 2015, Chinese leader Xi Jinping unveiled his signature 'Made in China 2025' industrial strategy, which identified biopharma and advanced medical products as key sectors for development in its broader push to reduce the country's reliance on foreign technology. The Covid-19 pandemic further exposed global dependence on China for pharmaceutical supplies – and served as a reminder to Beijing of the strategic advantage that that dominance provides. In a state-run magazine in 2020, Xi said China must consolidate its leadership in its advantageous industries, and 'tighten global industrial chains' dependence on China to build strong countermeasures and deterrent capabilities against deliberate external supply cutoffs.' In 2015, Chinese leader Xi Jinping unveiled his signature 'Made in China 2025' industrial strategy, which identified biopharma and advanced medical products as key sectors for development in its broader push to reduce the country's reliance on foreign technology. Tingshu Wang/Pool/Getty Images In 2021, during the height of the epidemic, China's National Development and Reform Commission, the state planner, highlighted APIs as a 'key strength in China's pharmaceutical industry's participation in global competition.' Li Daokui, a professor of finance at Tsinghua University in Beijing and a Beijing adviser, even suggested that China, given its strategic position in the production of raw materials for vitamins and antibiotics, could limit drug supplies to the US as 'countermeasures' against American sanctions. 'Not effective' While Trump is not the first US president to push for onshoring drug production, he is the first to attempt it through the threat of sweeping tariffs. Some companies have fallen in line. British firm AstraZeneca, for instance, is shifting production of certain medicines from Europe to the US, following a $3.5 billion investment plan announced late last year. Similarly, companies including Johnson & Johnson and Eli Lilly have pledged to expand their US operations. But these companies primarily focus on patented drugs. Stephen Farrelly, global head of pharma and healthcare at Dutch bank group ING, noted that the US accounted for 44 percent of global pharmaceutical sales in 2023, making it imperative for makers of patented drugs to maintain a presence in the country. The story is different for generics because their margins are often half those of branded ones. 'Given their margin profiles, they can't afford to make long-term investment decisions with so much uncertainty around,' he said. 'If even possible, it would take in excess of five years to begin reshoring.' Tariffs on pharmaceuticals would eventually fall on patients, experts say, widening health disparities in an already strained health care system. Because generics are as much as 85 percent cheaper than branded drugs, low-income patients and those without health insurance rely on them disproportionately. An April study commissioned by the main American pharmaceutical lobby group, the Pharmaceutical Research and Manufacturers of America, revealed that a 25 percent tariff will increase costs of imported pharmaceuticals by $50.8 billion annually, causing prices to rise by 12.9 percent if passed to consumers. ING also found that a 25 percent tariff on a common generic cancer medication could raise its price by up to $10,000 for a 24-week prescription. Rather than achieving the intended goal of onshoring production, experts said the tariffs could risk pushing generics manufacturers to abandon the US market altogether. Piervincenzi warned that even modest tariffs could disrupt the supply of generics. 'There's very little profit there and any tariff would just result in [generic drug makers] being underwater and just exiting,' he said. Incentives other than tariffs are necessary to create a resilient drug supply chain, Piervincenzi said. And unlike with other industries, drug supply disruption or shortages could have life-threatening consequences. 'Each of these drugs, people's lives depend on them, and a single drug goes into shortage and a child can't get their cancer therapy, and it becomes a disaster, which you don't see if your favorite brand of ketchup's out of stock,' he said. 'You may be annoyed, but your life is not in danger.'


Egypt Independent
a day ago
- Egypt Independent
Aid distribution in Gaza has turned deadly. Here's what to know
CNN — A new program for getting desperately needed food into the hands of starving Palestinians in Gaza is only days old, but it's already mired in chaos and tragedy. Dozens of Palestinians have been killed over the past few days while on their way to trying to obtain aid from the Gaza Humanitarian Foundation (GHF). This group, backed by Israel and the US, is intended to replace the UN-led system of distributing aid in Gaza, to address a hunger crisis sparked by a monthslong Israeli blockade. Over the past week, tens of thousands of Palestinians have converged on distribution points run by GHF, hoping to grab one of the limited number of packages before they run out. For the past three days, Palestinian authorities and witnesses have accused Israeli forces of shooting dozens of civilians dead near one of the aid sites in Rafah. On Monday and Tuesday, Israel's military said it fired 'warning shots' toward what were described as 'suspects' approaching a military position, and the military was looking into reports of casualties. On Sunday, during the first deadly shooting, the military said it did not fire at civilians 'near or within' the distribution site, even as a military source admitted Israeli forces fired towards individuals about a kilometer away from the site. As international condemnation grows, here's what to know about aid and the humanitarian crisis in Gaza. What is the situation with food in Gaza? Israel halted all humanitarian aid into Gaza in early March, with government officials saying their goal was to force Hamas to accept new ceasefire terms and release hostages taken during the militant group's terror attack on Israel on October 7, 2023. The ban meant no supplies entered the territory for 11 weeks, pushing Gaza's 2.1 million people deeper into a hunger crisis. A UN-backed report warned in late April that one in five people were facing starvation and that the entire Gaza Strip was edging closer to famine. Faced with growing international pressure, Israel eased its blockade two weeks ago, allowing a small amount of aid to enter Gaza, to be distributed through UN channels as well as through GHF. But the amount of aid trickling in is nowhere near enough to meet the needs of the population, according to Palestinian officials and international aid groups. On the first day of GHF's delivery in southern Gaza last Tuesday, chaos broke out, as thousands of Palestinians rushed to receive food supplies, with Israeli troops firing warning shots into the air and the US contractors overseeing the site briefly withdrawing. Gaza's hunger crisis long predates Israel's total blockade, however. Since Hamas' attack, Israel has severely restricted the amount of aid that can enter the strip. And even before October 2023, Israel and Egypt had imposed a partial blockade on Gaza, meaning that 63 percent of the population was food insecure, according to the UN. What is GHF? GHF is a private, non-profit organization created with the backing of Israel and the US to take over aid delivery in Gaza, following Israeli accusations that Hamas was stealing some of the humanitarian aid that was destined for civilians. GHF relies on private military contractors for security and aims to replace traditional methods of aid delivery in Gaza employed by humanitarian organizations. On Tuesday, the organization doubled down on its mechanism, saying its work continues 'full-steam ahead' as it asserts it has delivered millions of meals in pre-packaged boxes to Palestinians. 'In an operating environment as complex and volatile as Gaza, that kind of safe, direct, and large-scale aid delivery is unprecedented,' GHF said in a statement. The group has faced internal turmoil – its executive director, Jake Wood, quit the day before GHF began operations in Gaza, and in a further blow, the Boston Consulting Group confirmed on Tuesday that it had canceled its contract with GHF. Palestinians carry food packages from the US and Israeli-backed Gaza Humanitarian Foundation, in Khan Younis, southern Gaza, on June 1. Abdel Kareem Hana/AP The foundation set up four 'Secure Distribution Sites' in southern and central Gaza aiming to feed around 1.2 million of Gaza's estimated 2.1 million population. That pales in comparison to the United Nations system, which relies on some 400 aid distribution points dotted up and down Gaza. The foundation coordinates with the Israeli military to designate specific routes for traveling Palestinians – many of whom must walk a long way through the devastated strip to get food – and issues warnings on Facebook against diverging from the designated roads. But it's unclear how many of those people are aware of these detailed instructions, nor how access to one of the hubs, designated SDS-01, takes them close to positions of the Israel Defense Forces (IDF). Over the past three nights, Palestinians appear to have come too near to these positions, and the IDF said Tuesday it had opened fire towards people who had left the designated route. The United Nations had warned that the Israeli military's involvement in securing the areas around the sites could discourage participation or lead to recipients facing reprisals. How has aid distribution changed and why? Before GHF arrived in Gaza, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and the UN's World Food Programme (WFP) were the main distributors of aid in the enclave. Additionally, UNWRA took a leading role in providing education and healthcare services. But Israel has long had a contentious relationship with UNRWA and the UN at large. This relationship ruptured completely in the aftermath of the October 7 attack. Israel's parliament subsequently banned UNRWA from operating in the country, making any UN-led humanitarian efforts extremely difficult. Both Israel and the US had also accused Hamas of stealing aid distributed by the UN. Hamas has rejected those claims, and humanitarian aid organizations say most of the food aid reaches civilians. The UN has refused to participate in the new Gaza aid initiative, saying that GHF model violates some basic humanitarian principles. It warned that locating the initial distribution points only in southern and central Gaza could be perceived as encouraging Israel's publicly stated goal of depopulating northern Gaza. GHF has said it is working to open new sites, including in northern Gaza, but no such distribution points have yet opened. What has been happening recently? There is not enough food for everyone who needs it. Tens of thousands of Palestinians have been forced to seek aid from a tiny number of sites – and while a lucky few have been able to secure some relief, for most, the results have been disastrous. Palestinian authorities have said more than 60 people have been killed by Israeli forces in the past three days near a GHF aid site near the southern city of Rafah. Establishing exactly what happened at all these incidents is difficult, as Israel prevents international media from entering Gaza. Emergency crews arrive to evacuate injured people after an Israeli drone reportedly opened fire on civilians near an aid distribution point near the Netzarim Corridor, central Gaza, on June 1. Eyad Baba/AFP/Getty Images On Tuesday, nearly 30 people were killed, and dozens wounded, according to the Palestinian Ministry of Health and Nasser hospital. The Israeli military said its forces opened fire multiple times after identifying 'several suspects moving toward them, deviating from the designated access routes.' On Monday, three Palestinians were shot dead and dozens wounded as they were on their way to access aid, Palestinian and hospital authorities said. The IDF said that Israeli forces fired warning shots approximately a kilometer (about 1,100 yards) from the aid distribution site. On Sunday, the Palestinian health ministry, hospital officials and a half-dozen eyewitnesses said the Israeli military was responsible for gunfire that Palestinian officials said killed 31 people. A Palestinian boy mourns loved ones who were killed by Israeli fire, as they gathered to try and access food near a US-backed aid center in Rafah, at Nasser Hospital, in southern Gaza, on June 3. Stringer/AFP/Getty Images At the time, the Israeli military said its forces 'did not fire at civilians while they were near or within' the aid site, but an Israeli military source acknowledged that Israeli forces fired toward individuals about a kilometer away, before the aid site opened. GHF said on Sunday that none of the gunfire was in the distribution center itself or the surrounding area. After Tuesday's shooting, the organization directed questions about shootings near the aid site to the IDF. 'This was an area well beyond our secure distribution site. We recognize the tragic nature of the situation and remain committed to ensuring the safety of all civilians during humanitarian operations at all of our sites,' GHF said in a statement. What has the reaction been? There has been widespread international condemnation, particularly from the UN. UN Secretary-General Antonio Guterres said Monday he was 'appalled' by the reports of deaths and injuries on Sunday. 'It is unacceptable that Palestinians are risking their lives for food,' Guterres said in a statement, calling for 'an immediate and independent investigation' into the events and 'for perpetrators to be held accountable.' The UN human rights chief, Volker Turk, said on Tuesday that Palestinians have been given 'the grimmest of choices: die from starvation or risk being killed while trying to access the meagre food that is being made available through Israel's militarized humanitarian assistance mechanism.' In a post on X, Philippe Lazzarini, executive director of UNRWA, also slammed the new mechanism, saying: 'aid distribution has become a death trap. Mass casualties including scores of injured & killed among starving civilians due to gunshots this morning. This is according to reports from international medics on ground.' The European Union's foreign policy chief, Kaja Kallas, last week criticized the new aid mechanism run by GHF, saying the EU does not support 'any kind of privatization of the distribution of humanitarian aid.' The leaders of the United Kingdom, France, and Canada have also threatened to take 'concrete action,' including targeted sanctions, if Israel does not stop its renewed military offensive and continues to block aid from entering Gaza.


Egypt Independent
2 days ago
- Egypt Independent
Many Palestinians killed near Gaza aid distribution point, health officials say, in third day of shooting
Jerusalem CNN — Palestinians on their way to receive aid from a distribution site in southern Gaza have come under fire for a third consecutive day, with nearly 30 people killed and dozens wounded, according to the Palestinian Ministry of Health and Nasser hospital. The ministry said Israeli forces opened fire on Palestinians as they made their way to the distribution site in Tel al-Sultan in Rafah early Tuesday. The Israeli military said its forces opened fire multiple times after identifying 'several suspects moving toward them, deviating from the designated access routes.' 'The troops carried out warning fire, and after the suspects failed to retreat, additional shots were directed near a few individual suspects who advanced toward the troops,' the Israel Defense Forces (IDF) said in a statement, which also said they are looking into reports of casualties. At least 27 people were killed and dozens injured, according to the Palestinian health ministry and the director of Nasser hospital in Gaza. Footage obtained by CNN showed people arriving at Nasser hospital in Khan Younis, many on stretchers. The firing occurred west of Rafah in the area surrounding the Al-Alam roundabout, according to paramedics from the Palestine Red Crescent Society, near the same location as shooting incidents the last two days. Early Tuesday morning, a Facebook page which the controversial US- and Israel-backed Gaza Humanitarian Foundation (GHF) has used to publicize information about the opening of distribution sites said one location would be open in southern Gaza and warned residents to adhere to a designated corridor starting at 5 a.m. 'The IDF will be in the area to secure the safe passage,' the statement said. But approximately one hour later, the page said the site will be closed. CNN has reached out to the GHF for comment. The incident marks the third day in a row that people have been killed on their way to the GHF distribution point west of Rafah while attempting to secure food as famine conditions worsen in Gaza following an 11-week blockade by Israel. Three Palestinians were shot dead and dozens wounded as they were on their way to access aid from the site on Monday morning, Palestinian and hospital authorities said. The Israel Defense Forces (IDF) said that Israeli forces fired warning shots approximately a kilometer from the aid distribution site and that it was looking into the details of the incident. On Sunday, dozens of Palestinians were shot dead by the Israeli military in the same area, according to Palestinian officials and eyewitnesses. Israel's military denied that its troops fired 'within or near' the aid distribution site. Palestinian officials said 31 people had been killed and scores wounded in Sunday's incident. An Israeli military source acknowledged that Israeli forces fired toward individuals about one kilometer (1093 yards) away before the aid site opened. This is a developing story and will be updated.