Dutch authorities had rung alarm bells about the “psychotic behaviour” of a medical student suspected of a shooting and arson rampage through Rotterdam in which three people were killed, his hospital boss said on Friday. The Public Prosecution Service had written earlier in the year to the Erasmus university hospital about the student suspected of shooting dead his neighbour, her 14-year-old daughter, and a teacher at the hospital. The man, named locally as Fouad L, displayed “worrying” and “psychotic” behaviour, including lying half-naked on a pile of leaves in his garden and laughing maniacally, prosecutors told the university in an email confirmed to be authentic by the public broadcaster NOS. Authorities had also examined the 32-year-old’s phone and found images of people being stabbed, along with far-right propaganda, according to the email. Prosecutors wrote in the email: “I assume this will influence your decision as to whether he is eligible for the basic medical diploma.” The chair of the hospital, Stefan Sleijfer, told NOS that L had passed all the tests required to become a doctor but the hospital had ordered a psychiatric exam after receiving the email. Sleijfer said: “We got warnings from the public prosecutor, who had doubts as to whether this person could become a doctor, given his other behaviour. We took this seriously.” The process of setting up a psychological assessment was ongoing, so the student had not yet received the medical diploma enabling him to practise medicine. The suspect, now in custody, first stormed into his neighbour’s house, shooting dead a 39-year-old woman and severely wounding her 14-year-old daughter, who later died of her injuries. He set fire to their house and then headed to the hospital, bursting into a classroom and shooting dead a 43-year-old teacher. Police had initially said the teacher was 46 before correcting his age. Dressed in combat gear and wearing a bulletproof vest, the gunman went to the main wing of the hospital and set the building ablaze, causing panic as medical staff tried to evacuate patients, some in wheelchairs and stretchers. Police said the suspect was cooperating with their inquiry. A motive has not yet been given. The suspect had been convicted of animal cruelty after abusing his pet rabbit and prosecutors said in their letter that his acts had been filmed by a neighbour. It was not yet clear whether the neighbour was the person he shot. He is thought to have held a deep grudge against the hospital. Police said he had acted alone and that the killings were “targeted”, not random. Residents began laying flowers outside the hospital and the house where the woman and her daughter were killed. Classes have been cancelled at the hospital and psychological support has been put in place for those affected by the shootings. The hospital, however, is fully functional again for patients and staff. Flags were flown at half mast. There are about 25,000 people in the hospital and the shootings occurred during rush hour, so there are a lot of traumatised people to care for, said Sleijfer. “We have the most vulnerable people in society here. Everyone pulls together to care for sick people. It’s really terrible that one of our colleagues simply got shot.”