Conflict-Related Disruption of Maternal Health Services: A Case Report of Maternal Death in Transit Due to Obstructed Labour in Somalia

Maternal mortality remains a major public health challenge in fragile and conflict-affected settings, where insecurity can disrupt referral pathways, skilled birth attendance, and timely emergency obstetric care. This case report describes a maternal death in transit from a remote nomadic community in Mahas District, Hirshabelle State, Somalia, and uses the Three Delays Model to frame the health-system failures contributing to the outcome. A 22-year-old primigravida woman developed prolonged labour at home under the care of a traditional birth attendant. The nearest district health facility had reportedly been non-functional for approximately six months because of insecurity and armed conflict, leaving no nearby access to skilled obstetric assessment or emergency obstetric care. As her condition deteriorated, the family attempted referral to Baladweyne Regional Hospital, but she died during transport before reaching the facility. Based on the reported history and clinical course, the death was most consistent with obstructed labour complicated by delayed access to emergency obstetric care. This case illustrates how conflict-related facility closure, weak referral systems, transport barriers, and lack of antenatal and skilled delivery care can combine to create a fatal second delay. It highlights the need for context-specific strategies to maintain essential maternity services in insecure districts, strengthen referral transport and communication, improve community recognition of obstetric danger signs, and protect emergency obstetric care for remote and nomadic populations.