They don’t! It’s not sure. Basically get data and use signal or session app to call.

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I have spotty internet in places where I need to make outgoing calls

So VoIP calls aren't reliable in emergency situations

Are you looking for privacy?

Not in this case

The try out Airalo. I’ve used it in US, Mexico, UK and most of Europe

https://ref.airalo.com/SQ4p

If you make legacy phone calls you get voice fingerprinted anyway, even if you haven't paid with your card or provided your ID explicitly

And you can call 911 or 112 even without any sim

Voip too? (Not e2e like signal)

Just legacy calls. Not VoIP. It has SSL at least.