Two people died and a teenager was left fighting for her life after a gunman dressed in combat fatigues and a bulletproof vest opened fire at a house and a hospital in Rotterdam on Thursday.
Dutch police said they were still investigating the motive for the twin attacks by the 32-year-old man, who also set fire to the hospital and the house.
The man first burst into a house in the Dutch port city and opened fire, killing a 39-year-old woman and seriously injuring her 14-year-old daughter, police chief Fred Westerbeke told reporters.
He then moved to a classroom at the Erasmus MC university hospital, shooting dead a 46-year-old teacher before starting another fire in the facility, sparking panic.
Elite police stormed the hospital, as panicked medical staff in white coats flooded out of the building pushing patients in wheelchairs and on stretchers.
He was taken into custody shortly afterwards and chief public prosecutor Hugo Hillenaar told reporters the suspect was cooperating with police following his arrest.
"We cannot say anything about the motive of this terrible act at this time. The probe is still ongoing," said Hillenaar.
The suspect was thought to have possessed only one firearm and there is no indication he had accomplices, authorities said.
Police said the suspect, a student at the hospital, was already known to the authorities over a conviction for animal cruelty.
An investigation is underway as to whether he was a pupil of the teacher shot dead. Authorities believe that the woman and her daughter were close neighbours of the suspect, leading Westerbeke to suggest they were "targeted attacks."
He had earlier been described as wearing "combat-style" clothes, was tall, with black hair and carrying a backpack.
"I am angry and sad," said Rotterdam mayor Ahmed Aboutaleb.
"We have been shocked by a horrific incident... the emotion in the city is running high," the mayor told reporters.
- 'Panic and screaming' -
Witnesses described the chaotic scenes around the hospital, as helicopters buzzed overhead and police snipers took up positions on the hospital roof.
"First there was a shooting on the fourth floor. Four or five shots were fired. Then a Molotov cocktail was thrown into the education centre," said a medical student quoted by RTL Nieuws, who did not give his name.
"There was a lot of panic and screaming... I didn't hear any shots, just the panic and that's what I started to act on," public broadcaster NOS cited another eyewitness as saying.
Prime Minister Mark Rutte spoke of his "great dismay" at the shootings.
"My thoughts go out to the victims of the violence, their loved ones and all those who have been hugely scared," he added in a statement on X, formerly Twitter.
King Willem-Alexander and Queen Maxima said their hearts went out to those suffering "intense grief."
"It's unbelievable," said Rotterdam GP Matthijs van der Poel, cited on the Algemeen Dagblad website.
"Everyone is totally shocked by the events and is watching the news with horror. I'm afraid such things cannot be prevented," he said.
Rotterdam is often the scene of shootings, usually attributed to score settling by rival drug gangs.
In 2019, three people were shot dead on a tram in Utrecht, sparking a huge manhunt.
And in 2011, the country was left shocked when 24-year-old Tristan van der Vlis killed six people and wounded 10 others in a rampage at a packed shopping mall.
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