Despite repeated technical assessments, confirmed financial capacity and clear structural proposals, the SNS and INEM keep failing to deliver timely emergency responses. This analysis points to implementation gaps — weak governance, fragmented coordination between national and regional bodies, staffing shortages and poor resource allocation — rather than lack of solutions; the result is delayed care that harms patients (including expats) and undermines public wellbeing. Addressing the problem requires transparent accountability, an independent audit of operational bottlenecks, data-driven redistribution of resources and political commitment to implement already-defined reforms.