Tropical cloud forests (TCFs) are one of the world's most species- and endemism-rich terrestrial ecosystems. TCFs are threatened by direct human pressures and climate change, yet the fate of these extraordinary ecosystems remains insufficiently quantified. With discussions of the post-2020 biodiversity framework underway, TCFs are a defining test case of the success and promise of recent policy targets and their associated mechanisms to avert the global biodiversity crisis. Here we present a global assessment of the recent status and trends of TCFs and their biodiversity and evaluate the efficacy of current protection measures. We find that cloud forests occupied 0.4% of the global land surface in 2001 and harboured ~3,700 species of birds, mammal, amphibians and tree ferns (~15% of the global diversity of those groups), with half of those species entirely restricted to cloud forests. Worldwide, ~2.4% of cloud forests (in some regions, more than 8%) were lost between 2001 and 2018, especially in readily accessible places. While protected areas have slowed this decline, a large proportion of loss in TCF cover is still occurring despite formal protection. Increased conservation efforts are needed to avert the impending regional or global demise of TCFs and their unique biodiversity.