SAN'A, Yemen  — Three American medical workers were shot and killed, and an American pharmacist seriously wounded, when a gunman opened fire inside a Southern Baptist missionary hospital in southern Yemen Monday.

Anonymous Yemeni officials later said a 30-year-old Islamic extremist had been arrested. Ties to Al Qaeda could not be immediately established.

Americans have been often urged to be cautious in Yemen, a poor, largely lawless country at the base of the Arabian peninsula known as a haven for Islamic militants and as the ancestral homeland of Usama bin Laden.

Local authorities said the gunman entered the complex of Jibla Baptist Hospital in the town of Jibla cradling what appeared to be a child — but was in fact a semiautomatic rifle — under his jacket. He then opened fire, killing the three Americans instantly.

A statement from the Richmond, Virginia-based Southern Baptist Convention's International Mission Board, which runs the hospital, said the three were holding a morning meeting.

The gunman then headed to the hospital's pharmacy and opened fire, wounding the pharmacist, they said. Jibla is in Ibb province, 125 miles south of the capital, San'a.

According to the International Mission Board, the three Americans killed were 60-year-old hospital administrator William Koehn of Arlington, Texas, who had planned to retire next year after 28 years of service; 53-year-old purchasing agent Kathleen Gariety of Wauwatosa, Wis.; and 57-year-old physician Martha Myers of Montgomery, Ala.

The injured victim was 49-year-old pharmacist Donald Caswell of Leveilland, Texas.

The three dead were shot in the head, Yemeni security officials said.

Caswell was shot in the abdomen and hospital officials said he was in critical condition and struggling for his life. The hospital was cordoned off as forensic experts gathered evidence.

"We just thank the Lord that he is alive," Caswell's father, 71-year-old D.C. Caswell, said from Texas. "He's alert and talking and everything's going to be all right, they're thinking."

"We are devastated by this news," International Mission Board spokesman Larry Cox was quoted in the statement as saying. "We are moving quickly to minister to family members located in Yemen as well as the United States."

Cox said no decision had been made about evacuating Americans connected with the hospital.

Carrying weapons is common in Yemen, where people often take them openly into offices and public buildings.

The official Yemeni news agency Saba quoted an Interior Ministry official in identifying the assailant as 30-year-old Abed Abdul Razak Kamel.

The official said that under interrogation, Kamel admitted plotting the attack in collaboration with Ali al-Jarallah, described by Yemeni officials as a Muslim extremist and member of Yemen's fundamentalist Islamic Reform Party, and who was himself arrested for shooting dead a senior Yemeni leftist politician on Saturday.

The Interior Ministry official, who was not identified further, said without elaboration that security forces have doubled their efforts to protect foreigners.

Another security official, speaking on condition of anonymity, said authorities were searching for a cell made up of five to eight people targeting foreigners and secular personalities in Yemen. He did not provide further details.

The U.S. Embassy in San'a issued a brief statement, posted on its Web site, condemning the attack "on American citizens who have long been providing humanitarian services to Yemeni citizens at the Baptist hospital in Jibla."

"We call upon the Yemeni government to bring those responsible to justice," the U.S. Embassy statement said.

The embassy also asked Americans in Yemen to enhance their security and said it was requesting additional protection for them in addition to sending a team to Jibla to help with the investigation.

Yemeni security officials said a helicopter carrying a U.S. team that included doctors landed in Jibla shortly after the attack.

It was the second recent attack on American missionaries in the Middle East. On November 21, a gunman shot and killed an American missionary nurse in the Lebanese city of Sidon. Lebanese authorities have yet to determine who was behind that shooting.

The International Mission Board's Web site said the hospital in Jibla treats more than 40,000 patients annually, providing care free to those cannot afford it.

The board's web site said that besides their work at the 80-bed hospital, missionaries taught English and clinical skills at a nearby Yemeni nursing school.

"We've been there for 35 years," said Wendy Norvelle, spokeswoman for the International Mission Board, in Richmond.

Kathleen Gariety had been in Yemen for about 10 years and along with her hospital work had helped educate Yemeni children, said her brother Jerome J. Gariety Jr. of Colgate, Wis.

"She was a wonderful, devoted person," he said. "She loved the children very much."

The Associated Baptist Press reported earlier this year that the International Mission Board, to save money and sharpen its focus on evangelism, was preparing to transfer control of the hospital to a local charity founded by Yemeni Foreign Minister Abu Bakr al-Kerbi, who is a Canadian-trained doctor.

Under the proposal, Southern Baptist medical missionaries would continue working at the hospital. It was not immediately clear how far the transfer had progressed.

The killings are "a crime unacceptable in any religion. This contradicts Islam," said a Jibla woman who gave only her first name, Fatima, and said she used the hospital. "They cared for us and looked after us. I can't even count the number of children they treated and saved."

Impoverished, factionalized, predominantly Muslim Yemen has for years been a haven for wanted Muslim extremists. Bin Laden enlisted thousands of Yemenis to fight alongside the mujahedeen of Afghanistan in their U.S.-backed war against an occupation Soviet army in the 1980s. Many returned when the Soviets withdrew, and they are a powerful political force here.

In one of several such alerts, a Nov. 14 U.S. Embassy message to Americans here said the U.S. government "continues to receive credible warnings that additional terrorist activities against Western and American interests in Yemen are being planned."

On Oct. 6, an explosives-laden boat rammed the French oil tanker Limburg off the coast of Yemen, killing one member of the tanker's crew, tearing a hole in the vessel and spilling some 90,000 barrels of oil.

An intelligence official in Washington has said U.S. experts believed the Limburg attack was the work of unspecified operatives with links to Al Qaeda.

Statements attributed to bin Laden and his network's "political bureau" hailed the explosion on the tanker but wouldn't confirm Al Qaeda's responsibility.

The French tanker scenario recalled the Oct. 12, 2000, attack on the USS Cole, which was rammed by a small, explosives-laden boat in the southern port of Aden.

Seventeen U.S. sailors were killed in that attack, which was blamed on Al Qaeda. Al Qaeda also is held responsible for the Sept. 11, 2001, attacks in the United States.

Yemen has signed on as Washington's partner in the war on terrorism launched after the Sept. 11 attacks.

Yemeni security officials, speaking on condition of anonymity, say up to 3,000 U.S.-trained Yemeni troops have been deployed recently in areas known to harbor wanted Al Qaeda members.

In November, a CIA-operated Predator drone flying above the Yemeni desert fired a missile that killed bin Laden's top lieutenant in the country, Qaed Salim Sinan al-Harethi, and five other Al Qaeda suspects, including one American.

The American was believed to have been the ringleader of the so-called "Buffalo Six," a group of American-born men of Yemeni ancestry who were arrested this fall on suspicion of being part of an Al Qaeda cell operating in western New York state.

Quoted:
I know people aren't going to like me for saying this, but these 3 are pretty stupid for being there in the first place.

May God save thier souls for assisting the heathens.

Quoted:
Look, folks.  The victims were non-Muslims, Americans, probably Christians, working at a Christian hospital in a Muslim country.
From a radical Islamist point of view, the whole thing is an insult to Islam, and the only sad part is that more were not killed.