Despite their limited spatial extent, freshwater ecosystems host remarkable biodiversity, including one third of all vertebrate species. This biodiversity is declining dramatically: globally, wetlands are vanishing three times faster than forests and freshwater vertebrate populations have fallen more than twice as steeply as terrestrial or marine populations. Threats to freshwater biodiversity are well- documented but co-ordinated action to reverse this decline is lacking. We present an Emergency Recovery Plan to “bend the curve” of freshwater biodiversity loss. Priorities for action include: 1) accelerating implementation of environmental flows, 2) improving water quality, 3) protecting and restoring critical habitats, 4) managing exploitation of freshwater species and riverine aggregates, 5) preventing and controlling non-native species invasions, and 6) safeguarding and restoring river connectivity. We recommend revised targets and indicators for the Convention on Biological Diversity and the Sustainable Development Goals, and investment in enabling conditions at national, river basin and local scales.