The Hailiutu River Basin in northern China represents a semi-arid area where groundwater-dependent ecosystems (GDEs) play a critical role in maintaining regional vegetation structure and ecological stability. This study investigated the spatiotemporal dynamics of GDEs and their relationship with water conditions using trend analysis, partial correlation, and Random Forest models over the period of 2002-2022. The results show that vegetation activity (NDVI) increased at a rate of 0.0052/yr in GDEs. Precipitation exhibited a basin-wide upward trend of 0.735 mm/yr, while SPEI increased at 0.0207/yr. In contrast, groundwater storage declined markedly at -11.19 mm/yr, highlighting a persistent reduction in water availability that poses a significant risk to the stability of GDEs. Both partial correlation analysis and the random forest model consistently showed strong ecohydrological interactions between vegetation and groundwater. Vegetation dynamics are primarily driven by groundwater availability, especially in groundwater-dependent ecosystems. Conversely, groundwater variations are most strongly influenced by vegetation. The results indicate that precipitation and the standardized precipitation-evapotranspiration index (SPEI) are the primary positive drivers of interannual NDVI variability, whereas groundwater plays a critical role in sustaining GDEs. Field observations of key species confirm the dependence of GDEs on groundwater, and vegetation dynamics are regulated by climate and groundwater; however, ongoing groundwater decline may threaten ecosystem stability. These findings demonstrate that vegetation transpiration exerts the dominant influence on groundwater variations, while groundwater simultaneously constrains vegetation growth, particularly in areas where declining groundwater storage anomalies (GWSAs) coincide with reduced NDVI. The results emphasize that continuous groundwater depletion threatens vegetation-groundwater sustainability, highlighting the need for balanced groundwater and vegetation management in arid regions.