Climate change and population growth are intensifying water scarcity in arid regions, yet previous analyses focusing on a single driver may not fully capture the compounded effects of climatic and anthropogenic factors. This study integrates water-balance analysis, trend analysis, and correlation-based statistical analysis to examine the combined effects of hydroclimatic anomalies and socioeconomic activities on water resource dynamics in ecologically vulnerable Northwest China. Our results show that despite increasing precipitation, warming-associated increases in evapotranspiration, together with irrigation-based water use accounting for 89.8% of total consumption, have offset the potential runoff gains, suggesting that agricultural water use is a major anthropogenic contributor to regional water stress. Based on these findings and a comparative review of representative arid-region practices in Israel, Australia, and Saudi Arabia, we propose a technology-market-institution tripartite governance framework for Northwest China. This framework is intended to support more proactive adaptation in regional water management and to provide a context-specific reference for advancing SDG 6 and SDG 13 in dryland regions.