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From a general perspective, all activities related to mining are one of the largest sources of metal pollution all over the world. FYR Macedonia is a metal-rich country where, as well as lead and zinc, other metals are also exploited. Furthermore, when dealing with mining, tailings dam failures are often closely related to such activities. Many environmental disasters related to mining have happened all over the world, one of which occurred in eastern FYR Macedonia. The collapse of the Sasa tailings dam left a great footprint on the adjacent area. Therefore the present study was conducted to determine the concentrations of potentially toxic elements (PTE) and rare earth elements (REE) in the surficial sediments and water of Lake Kalimanci and also in the fauna and flora. Majority of studied samples have heavily increased levels of PTE, which are also highly bioavailable under normal conditions. The accomplished HRI disclosed that V. melanops can pose a significantly high health risk for inhabitants, therefore it can be conclusively considered as highly contaminated with PTE and can consequently harm human health, especially for children in their early development stages.