Over the past decade, Israel achieved substantial reductions in emissions from electricity generation, transport, and regulated industry through coal-to-gas transition, solar expansion, and stringent emission standards. Despite these gains, ambient air pollution remains the country’s leading environmental health burden, causing an estimated 4,641–6,166 premature deaths annually with economic losses exceeding seven billion USD. Official data from Israel’s 2024 Pollutant Release and Transfer Register reveal a paradox: uncontrolled open waste burning (mixed municipal solid waste, e-waste and agricultural residues)–predominantly across the West Bank and around the Green-Line (1949 armistice boundary)–now accounts for 75% of carcinogenic emissions and 27% of PM2.5 in the national inventory. These transboundary plumes expose Palestinian and Israeli urban and rural communities to acute and chronic health risks, including premature mortality, cardiorespiratory and metabolic disease, and might elevate cancer risk. This perspective argues that reliance on enforcement-only and short-term mitigation measures is structurally insufficient. Instead, a systemic, infrastructure-first approach–grounded in waste separation, material recovery, and waste-to-energy (WtE) for residual fractions–might offer a more effective and technically credible pathway to eliminate the phenomenon at its source. A coordinated, cross-border institutional framework, supported by bilateral monitoring, shared treatment capacity, and international finance can advance air quality, environmental justice, and regional stability with climate co-benefits.