The self-declared Republic of Somaliland is grappling with high child and maternal mortality rates, malnutrition and inadequate medical personnel, health officials told IRIN. 'Somaliland has one of the worst maternal mortality ratios in the world, estimated to be between 10,443 and 14,004 per 100,000 live births,' said Ettie Higgins, head of the UN Children’s Fund (UNICEF) field office in Hargeisa, capital of Somaliland. 'The infant mortality rate is 73/1,000 while the under-five mortality [rate] is about 117/1,000. Fully immunized children represent a mere five per cent. Environmental sanitation is highly challenged,' she said.