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Introduction: Conjoined twins are rare congenital malformations that occur in identical twins who share both a placenta and an amniotic sac. If one twin dies, emergency separation is necessary to save the other twin. Case presentation: A pair of conjoined twin girls, one stillborn and one alive, was referred to our facility 18 hours after delivery from a primary health facility. The twins were diagnosed at birth in a primigravida who had obstructed labor and were delivered by emergency cesarean section. They were joined at the lower chest and upper abdomen and had separate umbilical cords. Imaging studies to determine the extent of organ involvement in the twins were not conducted due to the unavailability of the necessary equipment at our facility. By the second day of life, the surviving twin showed sepsis and was given intravenous fluids and antibiotics. On the sixth day of life, they were taken to the operating room for separation. The twins shared part of the abdominal wall, part of the chest wall and had fused livers, all of which were separated. Following the operation, the surviving twin was treated for sepsis and received nutritional rehabilitation. After a hospital stay of six weeks she was discharged home. Conclusion: An urgent operation to separate conjoined twins when one of them is stillborn is mandatory, even in a setting with limited diagnostic and surgical capabilities.