Fighting broke out in the east of Somaliland on Monday morning between regional forces and anti-government fighters, Somaliland's interior minister said, a month after some 20 people were killed in protests over control of disputed areas.
Somaliland's interior minister, Mohamed Kahin Ahmed, blamed militias allied with the elders for the violence, accusing them of attacking army camps.
"Around 5:30 early this morning, forces armed with... mortars and rocket propelled grenades attacked some of the camps of the national armed forces," Ahmed told reporters.
"The attackers involved in the fighting are forces who have been organised by the traditional elders," he added.
Mohamed Farah, a doctor at Laascaanood Hospital in Laascaanood, the administrative capital of the Sool region, said at least 34 people were killed and another 40 injured in Monday's fighting. Farah said he had seen the bodies brought to the hospital.
A second doctor at the hospital confirmed the death toll and said the facility had been targeted with mortar shells.
Somaliland authorities could not immediately be reached for comment or confirmation on the death toll.
Somaliland's President Muse Bihi, whose administration governs from Hargeisa, around 380 kilometres (240 miles) to the west, warned that the authorities were ready to defend the republic against any threats to its sovereignty.
Control of Las Anod, located along a key trade corridor, has changed hands several times in recent decades.
Somaliland broke away from Somalia in 1991 but has not gained widespread international recognition for its independence, and has seen opposition to its claims over land on its eastern border with Puntland, one of Somalia's semi-autonomous regions.
A former British protectorate, Somaliland prints its own currency, issues its own passports and elects its own government, but its quest for statehood has gone unrecognized, leaving it poor and isolated.
The region has been relatively stable in comparison to Somalia, but recent months have seen a surge in political unease and violent demonstrations.
In October, a decision by the council of elders to extend the president's term after elections were delayed prompted opposition outcry, while demonstrators were killed in anti-government protests in August.
This report was compiled from Reuters and Agence France-Presse.