The Aral Sea was once the 4th largest inland water bodies in the world [1–3] with a volume of 1000 km3 and a surface area of 66000 km2 . It is situated west of the Pamir and the Tien Shan in a semi-arid to arid region .
The rivers Syr Darya and the Amu Darya fed the sea as well as all the fish living in it . Its water was scarcely touched during the 1950s . After World War II, Soviet Union Leader, Nikita Khrushchev (1953-1964), made water projects to increase economic output . This consisted of converting land surrounding the sea to be used mainly for cotton fields, and to a lesser extent rice [2,5–7]. At that time, the main objective was to convert cotton into "white gold" distributing and exporting cotton to textile factories in and outside Central Asia and Kazakhstan . The diversion of the water for the increase of cotton production was believed to drastically increase exports and feed the countries’ clothing material; from 1960 ~ 1980, cotton production almost doubled, the Soviet Union was producing a quarter of the world’s cotton; however declining hereafter [3,7]. In order to irrigate those newly planned fields, water reaching the Aral was to be diverted [1,2,8]. This led to a reduction of more than 75% of its water as scarcely any water reached the Aral Sea; in the first decades  there was a 25 m to 38 m water level reduction in the Sea [4,7]. By the early 1960s, as a consequence of the diversion of inflow, the Aral dropped from 50-60 km3 to 30 km3 in the 1970s and 1980s and to a mere 5 km3 in the period of 1989-1990 . It has become shallower and more saline, a study in 1991 reported the salinity levels had tripled, varying along the lake [2,6]; the Aral had become a dried land for breeding salt and for dust storms . The dust storms experienced in the drylands of the region are among those with the highest frequencies in the world [9–11]. Additionally, groundwater levels dropped as no water was present for infiltration . Some of the environmental concerns arising from the uncontrolled water management and irrigation practices include: reduction in water quality, waterlogging, salinization, water depletion; they threaten human health as well . The salinization in the water has led to a decreased crop yield and un-drinkable water . From pre1960 to 1990 the salinity had increased from 10g/l to 30g/l 7 and to 48 g/l in 1998 in the ‘Big Sea’ and to 21 g/l in the ‘Small Sea . A salinity study in 1999 revealed that the river water was unsuitable for drinking purposes, and in some cases infiltration to the ground had also contaminated phreatic aquifers . In 2015, a study reported that salinity varied from 10 g/l to 110 g/l due to extensive irrigation from the river water. Productivity dropped, leading to a deteriorated local living conditions and an increase of sickness and mortality rates . The environmental problems arising from this massive water diversion have ultimately affected development in the region . The disastrous plan led to human health, social, environmental and economic problems . About thirty-five million citizens have been affected by the reduction of the Aral Sea, losing access to the water, no longer being able to use the sea as a transport means, for fisheries, for reed beds, etc . Research shows that the regions problems related to health are undoubtedly linked to the underground and surface water contamination . The Aral Sea crisis received widespread awareness during 1986-1987, by then threshold levels had been exceeded . A turning point in the catastrophe happened in November 1989 when the USSR founded the government commission to begin an ecological restoration of the Aral Sea . Actions began in June 1990 when the commission auctioned measures for the ecological normalization of the Aral ; by then soviet scientists, international bodies (i.e. Japan) and money distributed for its rehabilitation began . By the time the Aral had dried up in most of the sea, environmental control and management measures started arising. By then, the Soviet Union was at the brink of collapse and efforts failed redundantly as the measures taken were small compared to the gravity of the problem . A lack of concern in the Russian scientific arena also arose during that time, Russian scientist Voyeykov suggested that the Aral Sea water was an unimportant body, that if it needed to dry up in order to use the rivers water for irrigation and agricultural purposes then it was to use it for beneficial use . The chemical fertilizers and pesticides used in the production of cotton have converted this place as one of the most polluted on earth  . By 1994, up to 150,000 tonnes of toxic chemicals had entered the water in the region . Ecological and environmental degradation due to the reduction of water reaching the Aral Sea has led to local climate change conditions . Temperatures have risen, summers are drier and longer and winters harsher. Additionally, research has also shown that during the 1950s, the soil was fertile and hummus rich; yet, after the irrigation practices the land became unfertile with low productivity yields . By June 1990, an agreement stating that the Aral basin was on the verge of ecological disaster was signed by the presidents of Kazakhstan, Uzbekistan, Tajikistan and Turkmenistan; it was stated that the problem was so big they could not solve it by themselves . However, the Soviet Union dissolved by December of 1991 and (like in the Chernobyl case) the responsibility and liability for the Aral Sea disaster fell to the independent republics . Although intergovernmental agreements were set for regulating water allocation, conflicts due to water sharing between the four countries in Central Asia arose in the 1990s, which had been previously controlled by the Soviet system . By 1994, optimism arose as the World Bank destined funds for the restoration of the Aral Sea, articles were published and research began; however, by 1997, no advancement had been done, especially related to health, and no hospitals were created to target the people affected by the Aral Sea disaster . Additionally, discrepancy arose in what was accepted by the World Bank in terms of health and published articles . By fall of the same year the five countries involved took the recommendations by the World Bank that suggested to leave the sea to die, since there was no chance in saving it and it was uneconomically feasible to restore it; the decision was made with no consideration of the local affected people i.e. Karakalpaks, people from a region in Uzbekistan . Several organizations arose in response to this decision i.e. “For an Environmental-Clean Fergana" Association, Perzent—Karakalpak and others . Some addressing different issues, i.e. environmental restoration, activism, women issues… Additionally, cotton is a state controlled commodity in Uzbekistan requiring water intensive irrigation; the Uzbek government has done little effort to change cotton production since the end of the Soviet era . As a response to International pressure, the Uzbekistan government introduced the Water Users Associations (WUAs); a shared irrigation system by privatized and agricultural producers [3,14]. However, these organizations are weak, as cotton production remain in the country’s main agenda . In 2015, a resident affected by the Aral Sea recalls: “There was a beautiful beach, with waves coming up to the beach, it was wonderful. There were no fish in the Soviet Union like the fish in Aral. We thought that gradually life would get better” . Pyotr Bochov chief engineer says, “all the fruit trees are dead, and they never coming back, grass used to grow here, its’ all gone” . Some of the revitalization efforts: The Kokaral Dam was constructed and financed by the government of Kazakhstan and the World Bank as a measure to recover the northern part of the sea . Additionally, one of the measures taken by 1993 was installing water collector systems throughout the irrigation area to decrease the quantity of salts and toxic chemicals flowing to the sea . However, this led to disposing of it in inhabited places, moving the problem elsewhere . Trees have been planted to avoid the wind storms to carry dust pollutants.