In the Aral Sea Basin, where the Central Asian countries compete for limited water resources, reliable information on the actual water use for eight million ha of irrigated land are rare. In this study, spatially distributed land use data, seasonal actual evapotranspiration, and reference evapotranspiration derived from multitemporal MODIS data were combined with in situ water flow measurements for irrigation performance assessments in the upper Amu Darya Delta. The functioning of the major irrigation and drainage which supplies an agricultural area of 270,000 ha in the Uzbek province Khorezm was analysed using water balancing and adequacy indicators of irrigation water use. An average relative evapotranspiration of 95% indicated fulfilled water demands and partly over-irrigation, whereas values below 75% disclosed inadequate water supply in distant parts of the irrigation system. On the other hand, immense water withdrawals of approximately 24,000 m(3) ha(-1) recorded at the system boundaries between April and September 2005 clearly exceeded the field water demands for cotton cultivation. Only 46% of the total irrigation amounts were consumed for crop production at field level. Throughout the vegetation period, approximately 58% of the total available water left the region as drainage water. Monthly observations of the depleted fraction and the drainage ratio highlighted drainage problems and rising groundwater levels at regional scale. In the most distant downstream subsystem, a high risk of groundwater and soil salinity during the main irrigation phase was found. A combination of high conveyance losses, hydraulic problems, direct linkages between irrigation and drainage, and low field application efficiencies were identified as major reasons for underperforming irrigation. The findings underlined the necessity of water saving and of reconsidering water distributionin Khorezm. The remote sensing approach was concluded as a reliable data basis for regular performance assessments for all irrigation systems in Central Asia.