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North Macedonia, officially the Republic of North Macedonia, is a landlocked country in Southeast Europe. Its terrain is mostly rugged, located between the Šar Mountains and Osogovo, which frame the valley of the Vardar River. Three large lakes - Lake Ohrid, Lake Prespa, and Dojran Lake - lie on the southern borders, bisected by the frontiers with Albania and Greece. Ohrid is considered one of the world's oldest lakes and biotopes.

Organic pollution has been on the rise in the Danube over the last century, as human activities have resulted in increasing loads of wastewater rich in organic matter. The most serious organic pollution problems occur in tributaries that regularly receive untreated or inadequately treated wastewater from industrial plants and municipalities. Thanks to the significant improvement of wastewater infrastructure and services in the Danube countries, the basin-wide organic emissions reduced by 60% since the mid 2000s.

The Danube River Protection Convention forms the overall legal instrument for co-operation on transboundary water management in the Danube River Basin. The Convention was signed on June 29 1994 in Sofia (Bulgaria) and came into force in 1998. It aims to ensure that surface waters and groundwater within the Danube River Basin are managed and used sustainably and equitably.