Glaciers in the Himalaya–Karakoram mountain ranges harbour approximately half of the ice volume in High-mountain Asia and modulate the flow of freshwater to almost 869 million people within the Indus, Tarim, Ganges and Brahmaputra river basins. Since the mid-twentieth century, rising temperatures have led to unsustainably high melting rates for many glaciers, particularly in the Himalaya, temporarily increasing summer meltwater run-off but continuously reducing the ice-storage volume. In this Review, we discuss how and why glaciers and meltwater supplies have changed, how they will likely evolve in the future and how these changes impact water resources and water-related hazards. Heterogeneous glacier retreat is changing streamflow patterns, in turn, affecting the incidence of glacial-lake outburst floods and exacerbating the risk of flooding and water shortages associated with future climate change. These changes could negatively impact downstream populations and infrastructure, including the thriving hydropower sector and some of the world’s largest irrigated agriculture systems, by making water flow more extreme and unpredictable. An improved in situ monitoring network for weather, hydrology and glacier change is a crucial requirement for predicting the future of this resource and associated hazards, and their impact on regional water, energy and food security.