Background: After two decades of conflict, Somalia remains a fragile state where large scale displacement and inadequate access to functioning health services have left children vulnerable to morbidity and mortality from vaccine preventable disease. Children residing in the autonomous zone of Somaliland are similarly vulnerable to poor access to health care services. Following the conduct of a UNICEF-supported Multiple Indicator Cluster Survey in Somaliland during 2011 which captured information on immunization system performance, a survey was conducted to better understand the reasons for non-vaccination among children in Somaliland. Methods: The Somaliland Routine Immunization Non-Participation Survey (RINPS) was conducted in November 2012 to better understand the reasons for non-participation in both Child Health Days (CHDs) and Routine Immunization Services (RIS). RINPS was a cross-sectional household survey which used a two-stage sample design in order to obtain a representative sample of children 0 - 59 months of age residing in Somaliland. Thirty clusters were randomly selected from the 303 clusters for participation in the 2011 Somaliland MICS. A total of 867 children aged 0 - 59 months were identified and included in the analysis (overall response rate, 96%). Findings: Caregivers lacked motivation to take their children to CHDs and for RIS and lacked information about why children need immunization. Routine vaccination or CHD cards were available for few children at the time of the survey. Almost one-fifth of children aged 0 - 59 months in Somaliland had not received at least one dose of vaccine for DTP, polio or measles vaccine from either CHD or RIS. Conclusion: Child Health Days have a role in at least some area of Somaliland to expand the reach of immunization services. The availability and delivery of sustainable routine immunization services need to be strengthened in Somaliland with a strong social mobilization program to raise awareness about the importance of routine immunization.