A gunman dressed in combat gear and wearing a bulletproof vest went on a shooting rampage at a house and a hospital in Rotterdam Thursday, killing a 14-year-old girl, her mother, and a teacher.

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. The girl later died of her injuries.

He then entered 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.

One patient, Angeliek Vleesenbeek, said she was standing just outside the hospital having coffee when pandemonium broke out.

"It was drama. It really was drama," the 54-year-old told AFP, still hooked up to her intravenous drip.

Police shouted at everyone to run to a nearby school, she recounted. "They told us to stay there and we couldn't go outside again. I've been there for a few hours with other patients, nurses, doctors. I saw a witness crying," she said.

"You don't expect this in the Netherlands," 38-year-old civil servant Sem Built told AFP. "In the United States yes, but here in the Netherlands? I would never have expected a teacher (to be killed)," added Built, who watched the drama unfold from a nearby children's unit.

Built witnessed terrified people scrambling down from balconies in the hospital building. Photos in the local media show messages taped to hospital windows reading: "Room 32. We can't get out."

The gunman was taken into custody and chief public prosecutor Hugo Hillenaar told reporters he 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, reportedly for abusing his pet rabbit.

An investigation is underway as to whether he was a student of the teacher shot dead. One possible theory police have is that he was rejected for a course at the university hospital.

Authorities believe that the woman and her daughter were close neighbours of the suspect, leading Westerbeke to suggest they were "targeted attacks".

Police had earlier described the gunman as tall, with black hair, wearing "combat-style" clothes and carrying a backpack.

"I am angry and sad," said Rotterdam mayor Ahmed Aboutaleb, who spoke of a "very dark day" for his city.

"We have been shocked by a horrific incident... the emotion in the city is running high," the mayor told reporters.

Witnesses described the chaotic scenes around the hospital, as helicopters buzzed overhead and police snipers took up positions on the hospital roof.

Patient Vincent de Wee, 38, said he had been in isolation at the hospital, suffering complications from a rare form of cancer.

"It was strange. You don't expect it's going to happen. I was lying for 26 hours upstairs. I go outside for a smoke and the police are sending everybody away," added De Wee, who works in a hospital in Amsterdam.

"That's frightening. Maybe I passed him. The teachers, the students who saw what happened -- everyone was crying," he added.

Prime Minister Mark Rutte spoke of his "great dismay" at the shootings while King Willem-Alexander and Queen Maxima said their hearts went out to those suffering "intense grief".

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. (AFP)

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Last updated: 2023-09-29 HKT 04:11