The Aral Sea is located in the lowlands of Turan occupying land in the Republics of Kazakstan and Uzbekistan. From ancient times it was known as an oasis. Traders, hunters, fishers, and merchants populated this fertile site littered with lagoons and shallow straits that characterised the Aral landscape. The word â€œaralâ€ in Kazakh is translated â€œislandâ€, over a thousand of which were scattered throughout this region which made up part of the Silk Road, the highway between Europe and Asia. Once the fourth largest inland body of water in the world, in the past few years the Aral Sea has gained global attention as one of the greatest man-made natural disasters in the world. Now it is the eighth largest inland body of water on account of large amounts of water diverted for crop irrigation from the Amudarya and Syrdarya rivers. Extreme shrinkage of the once abundant Sea has altered the climate and the livelihood of millions of people.Irrigation increase in the 1960s began affecting the Aral ecosystem. South of the Sea lies the Amudarya delta, a 28,000 sq km area used for the production of rice and cotton, the regionâ€™s most profitable cash crops. In the days of the Cold War, the Aral Sea basin was designated by the former Soviet Union as land that would provide independence from the West. Although the region did produce heartily for a time, the devastating effects of desertification were not anticipated by the central planners. Now the Sea has in places retreated more than 100 km from its original boundaries.Abandoned fishing boats and scattered marine equipment litter the dry, dusty plains previously covered with water. As water quantity diminished, salinity rose to levels toxic for fish and other wildlife. The first drastic increase occurred between 1971 and 1975 when salinity rose to 12-14%. In the late 1980s the salinity reached 23%. An estimated 60,000 people abandoned their fishing livelihoods. Carp, bream, pike-perch, barbel, sturgeon, and many other types of commercial species of fish used to bolster profitable businesses. Commercial fishing ceased in 1982, and soon muskrat farms and other game trades followed suit. The diversity of the Aral Sea Basinâ€™s former biological life has been compared to Africaâ€™s. Of the regionâ€™s 500 species of birds, 200 species of mammals, and 100 species of fish most have perished over the past four decades. Water had been so heavily diverted that by 1995 hardly a stream reached the Sea from either the Amudarya in the south or the Syrdarya in the north. In the 35 years from 1960 to 1995 the Seaâ€™s surface area decreased by half, three quarters of water volume was lost, and its depth lowered by 19 meters.Due to a strong NE wind, over 100 million tons of salty dust blows away from the Sea annually. Aerosols are carried up into the higher layers of the atmosphere and spread all over the globe; Aral region pesticides have even been found in Antarctic penguins. The dust contains an unhealthy mixture of fertiliser and other agricultural chemicals and household waste. Salt and pesticide chemicals have seeped into groundwater and caused health disasters and further complications for agriculture. Polluted water runs down into lowland reservoirs causing secondary salinization and making irrigation less effective. The latter exacerbates the agricultural difficulties because more water is needed to attain a healthy crop. The State Hydrometeorological Committee of Uzbekistan reported data in 1989 that the content of 6-valent chromium, copper, phenols, and sulphates reached well above the maximum allowed concentration of contaminants allowed in Russia and the former USSR.Â Perhaps the most significant factor of the Aral Sea crisis is the health of the people. Hospitalisation rates increased from 20 to 25 per 100 persons between 1980 and 1987. Mortality rates have increased by 15 times in a ten year period, and diseases such as cardiac, vascular, gallstone, and tuberculosis have risen significantly. The rise in child mortality has been attributed to environmental deterioration and now ranks highest in the former Soviet Union. The ecological disaster has been directly linked by medical studies to diseases of blood, cancer, asthma, and heart malfunction. Medecins Sans Frontieres (MSF), a non-governmental organisation, has begun a cooperation with the governments of Turkmenistan and Uzbekistan to implement DOTS, a World Health Organisation strategy used in over 100 countries world-wide to reduce tuberculosis. MSF began to pilot projects in 1998 and vouches to stay committed to the Aral Sea area in order to be certain the disease is effectively combated. â€˜Dots for Allâ€™, a program launched by MSF on 24 March 2000, seeks to reach outlying communities where labs and other facilities do not exist but thousands of people have tuberculosis. Currently over 2000 people die each year in the region from the TB epidemic, a number MSF believes can be considerably reduced by effective cooperation of the ministries of health and a thorough execution of â€˜Dots for Allâ€™.An estimated five million people have been devastated by the Aral Sea disaster. So far the largest effort to address the issues have been conducted by the World Bank and UN with goals to stabilise the Aral Sea level, rehabilitate the region and improve its water management. Although this project spent tens of millions of dollars in ten years, the first goal is no longer thought feasible, the second and third are just getting underway. In short-term response to this failure, in 1994 the United Nations Development Program (UNDP) sought to provide safe drinking water to 426 communities in the worst areas. The project closed in 1998 with reports of success accompanied by various shortcomings. Many pumps were of poor quality or were installed improperly resulting in over three quarters of them being contaminated after one year. Further proposals by the UN and World Bank are underway, but their success is doubted.In 1994 the governments and peoples of the republic of Kazakstan, the Kyrgyz Republic, the Republic of Tajikstan, Turkmenistan, and the Republic of Uzbekistan established the International Aral Sea Rehabilitation Fund (IFAS). The IFAS Executive Board sits in the city of Almaty and plans on continuing programs until 2015. Primary goals include:stabilizing and improving the environment of the Aral Sea Basinrehabilitating the disaster zonesimproving water resource managementincreasing the capacity of local and state institutions for planning and implementing programsThe expenses for rehabilitation of the region is estimated in the billions and expected to last decades. Donor countries met in Paris in 1994 to discuss Phase I of the Aral Sea Program. The World Bank, EU, Global Environmental Fund, UN Development Program, International Aral Sea Rehabilitation Fund, Kuwait, Japan, Switzerland, Canada, Italy, Netherlands, Great Britain, and Finland agreed to allocate 25,820,000 US$ to the cause. A number of Phase I preparatory initiatives have been carried out, but due to failure of some countries to provide the financial resources committed to in Paris, most projects of the Aral Sea Program lie in wait. This prompted Nursultan Nazarbaev, President of the Republic of Kazakstan, in 1997 to request the participating nations to extend their assistance and to support the Immediate Impact Project. The population in desperate need of assistance could not wait for various nations to make good on their long term promises. In December of 1997, 55 Muslim countries adopted the Resolution on Economic and Financial Assistance to the Government of the Republic of Kazakstan and to international organisations to aid the rehabilitation of the Aral Sea region. The government of Kazakstan has installed 800 large water-pipe systems to provide for 29 settlements. Large hospitals, pension plans, new jobs, and business developments have also taken course as an aid to people deprived of work, handicapped by disease, or left desolate by loss of family members.Motivated by geo-political issues, the United States government has pursued a policy through economic, political, and environmental assistance programs to assist Central Asian states. Central Asia borders Russia, China, Afghanistan, and Iran, besides the gas and oil rich reserves located in the Caspian Basin just a few hundred miles west of the Aral Sea. American business interests require a stable political and economic climate particularly in the energy zone. One way to encourage regional stability is through environment unity and cooperation. US international intervention has sought this in conjunction with the leaders of Central Asia. In 1997 Bill Clinton and Nursultan Nazarbaev agreed that more immediate action needed to take place in the Aral region. Through the Agency for International Development (AID) the US pursued the Aral Sea crisis by building a reverse osmosis plant in Dashhowuz, Turkmenistan, and constructing Chlorination facilities in the Amudarya delta. A regional environmental office was opened up in Tashkent, Uzbekistan to co-ordinate US programs. So far the US has made small but noticeable contributions to the effort. Some criticisms have noted the fact that the US has failed to cooperate with other donors. Whereas the World Bank sought out Central Asians and combined strategy and resources with the IFAS and the Interstate Council for Addressing the Aral Sea Crisis (ICAS), AID worked independently and many think less effectively than it otherwise would have. AID also dealt with the Central Asian states without collaboration from the World Bank or anyone else. Asian states ended up balancing different aid packages and separate sets of negotiations. Eventually confusion occurred regarding who was responsible for water allocation decisions and who ought to develop programs to address the overall Aral Sea region. Donors experienced difficulties and often overlapped one another. Much of what AID has desired to do involves the cooperation of upstream and downstream states. The latter have refused to pay for water and AID has tried to reach a compromise involving exchange of energy and water resources. The complicated issues of market reform, interstate water cooperation, democracy building efforts, and Aral Sea disaster cleanup require a unity in the organisation that proposes to address them. The US has been somewhat effective, but the efficacy of AIDâ€™s efforts could be improved by uniting and supporting the other organisations involved.In June 2001 five members of the European Parliament visited Uzbekistan. They spent two days in Karakalpakstan, one of the most effected areas in the region and experiencing a major drought at the time. MSF addressed delegates and requested permanent representation of the EU and ECHO in the Aral Sea region. The delegates planned to address the proposal in the near future.