The research aims to analyze the complex water balance, surface water quality, and water resources management in the Karaganda region. A thorough investigation involved examining 119 lakes and 12 rivers within the region. The study revealed that the annual river flow into the Karaganda lakes and their subsequent outflow from the territory was notably meager, accounting for only 0.935% and 3.031%, respectively, primarily due to the scarcity of water bodies in the region. As for water quality, none of the lakes qualify as “highly suitable water” (>50), necessitating further treatment to make them drinkable. Only a small fraction, 4.6% of the lakes, display water quality scores ranging from 50 to 100, indicating the urgent need for substantial remediation efforts. Additionally, a considerable proportion, 47.7% of the lakes, fell within the water quality range of 100-200, demanding treatment before appropriate use. Furthermore, a noteworthy 11% of the lakes were deemed “unsuitable for drinking” (>300), while 36.7% are classified as “very poor water” in the range of 200-300. In the context of Integrated Water Resources Management (IWRM), the aspects of stakeholder participation, ecosystem protection, and water quality management received the least favorable evaluations, with an average score ranging from 2.4 to 2.8.