Seven people have been shot dead and twelve others injured in a hospital in the Guatemalan capital, Guatemala City.
Police suspect the attackers were members of the Mara Salvatrucha criminal gang who were trying to free one of their jailed leaders.
The leader had been taken under armed guard to Roosevelt Hospital for tests.
The gunmen opened fire outside the emergency department killing two guards, two hospital workers, a bystander and two children.
Another child is among those injured and in critical condition, the hospital's deputy director said.
Five suspected gunmen were arrested at the scene but the gang leader they were trying to free managed to escape.
Anderson Daniel Cabrera Cifuentes, 29, was serving a sentence for murder. He is believed to be the leader of a local Mara Salvatrucha cell.
The gang, which is also known as MS-13, operates across Central America and in the United States.
Confusion reigned at the hospital in the hours after the shooting.
Local media reported that a medical student had suffered a nervous breakdown after a bullet hit his rucksack and got lodged in his 500-page Clinical Anatomy text book.
The maternity ward was surrounded by at least 50 police officers after reports that one of the fugitive gunmen was hiding inside.
Officers arrested a man but released him again after confirming he was visiting his wife who had just given birth to twins in the maternity ward.
Following the attack, President Jimmy Morales asked judges to stop sending convicted criminals to hospitals for tests.
He said that mobile clinics would be installed in the country's prisons to deal with prisoner's needs on location.
Guatemalan jails suffer from serious overcrowding and existing prison health centres have been used to house prisoners.