Drylands are among the ecosystems most vulnerable to anthropogenic pressures and climate change, yet they remain underrepresented in global conservation frameworks. Biodiversity conservation in these regions faces significant challenges due to trade-offs with socioeconomic development. Here, we applied the IUCN Red List of Ecosystems (RLE) criteria to assess ecosystem collapse risk in the Tarim River Basin (TRB), the driest region in China, using data on vegetation types and their distributions in 1980 and 2020. We found that 42 of 45 vegetation types were threatened due to land cover change, restricted geographic ranges, and projected climate change. Together, these threatened vegetation types accounted for 72.8 % of the total area assessed, mainly located in low-elevation regions with intensive land use. On average, national and provincial nature reserves covered only 7.6 % of these threatened areas. Notably, 20 threatened vegetation types were not covered by nature reserves. Ongoing expansion of cropland, along with the development of both renewable and fossil energy infrastructure, is likely to exacerbate vegetation degradation. Our findings highlight the urgent need for integrated land-use planning to reconcile biodiversity conservation and development goals in vulnerable dryland ecosystems.