Conjoined twins are rare, and those surviving beyond the first 24hrs occur about 1:200,000 pregnancies. There are often conflicting interests in their management. Medically, few are separable. The families may not want separation for emotional, religious and ethical reasons. Technically the surgery is often difficult and resource intensive. The occurrence of conjoined twins in a resource poor setting presents all these challenges. We present a case of successful elective separation of conjoined twins, in a resource poor setting.