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The risk assessment doesn’t require the company to assess the reliability of international diplomatic relationships. Having your data on EU soil (even under the care of a US company) is enough for compliance.
I assure you that is not true. Even in my “mild” domain of marketing analytics, vendors exist that are EU companies with EU storage also run by EU companies or they offer on-premise deployment. And serious companies with users that may signal personal details through behavioral data seek such solutions.
Vendors do exist but they are not required to do so. My last job was at a software vendor, GDPR compliant, ISO & SOC 2 certified, controlling personal data (including salary information) of EU citizens who were not opted in (their employer is the one on the contract). Not healthcare levels of sensitive but still pretty icky in terms of EU law and we had tons of German friends who are real sticklers for the rules. We stored everything on AWS infrastructure and it has never caused any issue during certification or security assessment by clients.