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The hospital Aziza Othmana is the oldest Tunisian hospital still exercise. This and the services he rendered, especially during the period when the country was poorly equipped in public health services, have earned him a historical dimension. This is reinforced by a heritage value related to the site, the hospital being located in the Medina, the oldest part of the city, and its first core was housed in a building of historical value.Such context and evolution have earned the hospital historical and heritage significance. But they did not have only advantages. The hospital sometimes even seemed victim of such prestige. On different occasions, it was obliged to cope with various constraints in a context where it was necessary to reconcile the requirements of the site and those related to the accomplishment of a mission requiring a specific workspace. In addition, the fact that the management did not always have the same objective and that the approaches varied from one period to the next have complicated the situation. During the first decades, one of the main concerns was to extend the hospital’s area to provide premises and care services necessary to face the growing demand of the population. But the extension of the workspace has been realized without a pre-established plan. This has not prepared for the present requirements for the exercise of a modern medicine. The site also begins to experience new constraints related to accessibility in relation with the expansion of the urbanization and the development of the car fleet.This paper tries to present the specificities of this hospital and the importance of its contribution especially at its beginnings. The goal is also, and above all, to try to understand the evolution since the creation of this institution. Particular attention is given to the built space and its organization as well as the duality between the requirements of its functionality and the fulfilment of the mission of care, on the one hand, and those imposed by the historical value and heritage interest of the site, on the other hand.

The hospital Aziza Othmana is the oldest Tunisian hospital still exercise. This and the services he rendered, especially during the period when the country was poorly equipped in public health services, have earned him a historical dimension. This is reinforced by a heritage value related to the site, the hospital being located in the Medina, the oldest part of the city, and its first core was housed in a building of historical value.Such context and evolution have earned the hospital historical and heritage significance. But they did not have only advantages. The hospital sometimes even seemed victim of such prestige. On different occasions, it was obliged to cope with various constraints in a context where it was necessary to reconcile the requirements of the site and those related to the accomplishment of a mission requiring a specific workspace. In addition, the fact that the management did not always have the same objective and that the approaches varied from one period to the next have complicated the situation. During the first decades, one of the main concerns was to extend the hospital’s area to provide premises and care services necessary to face the growing demand of the population. But the extension of the workspace has been realized without a pre-established plan. This has not prepared for the present requirements for the exercise of a modern medicine. The site also begins to experience new constraints related to accessibility in relation with the expansion of the urbanization and the development of the car fleet.This paper tries to present the specificities of this hospital and the importance of its contribution especially at its beginnings. The goal is also, and above all, to try to understand the evolution since the creation of this institution. Particular attention is given to the built space and its organization as well as the duality between the requirements of its functionality and the fulfilment of the mission of care, on the one hand, and those imposed by the historical value and heritage interest of the site, on the other hand.