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From the lead editor's nearly forty years of work on environmental disaster, there is a basic rule of thumb that has never disappointed (Edelstein, 2000, 2004). No matter how severe the direct impacts of a disaster are, at least half the stress comes from the secondary psychosocial impacts involved in dealing with the aftermath. In the case of the Aral Sea, most of the stress is back loaded. The population of Karkalpakstan, particularly those living by and working on the sea, was literally left high and dry, suffering substantial psychosocial and health impacts.¹