Climate change and human activities were identified as the primary drivers of streamflow in arid alpine regions. However, limitations in observational data have resulted in a limited understanding of streamflow changes in these water sources, which hinders efforts to adapt to ongoing climate change and to formulate effective streamflow management policies. Here, we use the four main tributaries in the upper reach of the Shiyang River in China as a case study to investigate the long-term trends in streamflow within arid alpine water sources, quantifying the individual contributions of climate change and human activities to these changes. The findings revealed that temperatures and precipitation in arid alpine regions have risen over the past 40 years. Although the warming trend has been significant, it has slowed in recent years. Nevertheless, three-quarters of the rivers are experiencing a decline in streamflow. The land types within the watershed remain relatively stable, with land use and cover change (LUCC) primarily occurring in the Gulang River watershed. Climate change has significantly affected streamflow change in high and rugged terrains, with an influence exceeding 70%. For example, Jingta River showed an impact of 118.79%, Zamu River 84.00%, and Huangyang River 71.43%. Human-driven LUCC, such as the expansion of cultivated and urban land, have led to increased water consumption, resulting in reduced streamflow. This effect is particularly pronounced in the low-lying and gently undulating areas of the Gulang River, where LUCC account for 78.68% of the change in streamflow. As human activities intensify and temperatures continue to rise, further declines in streamflow are projected, highlighting the urgent need for effective water resource management. These insights highlight the urgent need for targeted mitigation and adaptation strategies to confront the water scarcity challenges faced by these vulnerable regions.