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Global geopolitical tensions are quickly increasing the threat of significant transboundary radiological emergencies. The past nuclear and radiological disasters have highlighted critical deficiencies, yet the international healthcare system is still inadequately equipped for extensive nuclear and radiological crises. Our analysis of contemporary vulnerabilities, focusing on ongoing near-miss scenarios at the Zaporizhzhia Nuclear Power Plant and persistent systemic gaps in low- and middle-income countries (LMICs). The primary gap is the misalignment between global policy frameworks and frontline clinical preparedness. We suggest enhancing healthcare education, incorporating mental health into emergency preparedness strategies, strengthening early warning systems and transboundary radiological emergency response, and improving the availability of medical countermeasures. A standardized strategy is essential to enhance resilience in the face of future nuclear and radiological emergencies.