Mr Karimov's survival will depend, in part, on the attitude of the outside world.
Mr Karimov must balance the interests of competing clans who vie for control of lucrative sectors of the economy.
Simultaneously, Mr Karimov must keep the economy buoyant enough to forestall popular unrest.
Mr Karimov claims that the longer presidential term will strengthen democracy and give Uzbekistan's presidents more time to implement reforms.
Karimov to take further steps to modernize the country and said that a robust civil society would contribute substantially to Uzbekistan.
Earlier this year, President Karimov issued a decree ordering the privatisation of hundreds of state firms in an apparent effort to attract investment.
The drawback, for Mr Karimov, is the possibility of social unrest if the reforms led to unemployment and lower living standards, however temporary.
However, there are signs that Mr Karimov may be thinking that his autocracy is not providing a solution to all the country's problems.
Mr Karimov has insisted that his troops were not ordered to open fire and blamed the violence on Hizb ut-Tahrir, a banned Islamist group.
Mr Lemierre had been confident that Mr Karimov would publicly condemn torture, one of the first recommendations of a United Nations representative during his speech.
Mr Karimov's government has yet to comment on the ICRC's move.
Mr Karimov thinks the Islamist threat is so serious that in May he signed a pact with the Russian and Tajik presidents to counter fundamentalism.
Its president, Islam Karimov, said crossly this week that Russia was exaggerating the threat, and was trying to intimidate his country into accepting Russian bases.
Still, despite the open chumminess between Mr Karimov and Vladimir Putin, Russia's president, a Western diplomat suspects underlying tensions, for instance over gas sales and trade.
Mr Karimov is also thinking about liberalising the flagging economy.
Mr Karimov, who has led Central Asia's most populous state since before independence from the Soviet Union in 1991, decided that, in the interests of democracy, he needed an opponent.
Uzbekistan's president, Islam Karimov, who did not take part in the Bishkek meeting, appears to be seeking a different solution to the problem of Afghanistan: he is now trying to establish friendly relations with the Taliban.
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