This paper presents results of the research under the program Global International Waters Assessment (GIWA) for the Aral Sea basin (Subregion 24 of the GIWA program). These results show that the detemining factor for the region is freshwater shortage and the main issue is modification of stream flow. According to GIWA assessment estimations, freshwater shortage is responsible for about 70% of the developmental problems in the region. The current economy is developing under conditions of increasing water deficiency. In spite of increasing efforts by the governments of the countries in the region, and by the international community, the situation in regard to water supply and economic objectives in the countries of central Asia remains tense and shows clear tendencies towards aggravation and conflict. The main causes for this sharpening of ecological and socioeconomic conditions in the region are analyzed, and measures to mitigate stress in transboundary water-resources use are presented.