Background Violence in the health work place is actually a serious problem in Tunisia. This phenomenon can be explained by the weakness of the security measures in the health facilities, but also by other causes such as lack of health staff or equipment which make timeouts very long and create a kind of pressure in the health care settings.

In Tunisia, the overall situation has changed since January 2011 when the revolution occurred; the general situation in the country became characterised of violence and insecurity. Some national actions have been taken by Ministry of Health in late 2011 in order to eliminate this phenomenon in the health care settings.

Methods The aim of this research is to assess the situation in our health care settings before and after the actions undertaken in 2011. The research was performed from data collected by the Shocroom (strategic health operations centre), freely provided by the public health facilities. We collected 521 cases between 2011 and October 2015.

Results 521 incidents of verbal and/or physical violence against health workers were reported between 2011 and October 2015. The monthly average of incidents between 2011 and 2015 is as follows:

• 8.16 is the mean of incidents of violence against health workers reported to the Shocroom in 2011.

• 14.08 is the mean of incidents of violence against health workers reported to the Shocroom in 2012.

• 11.08 is the mean of incidents of violence against health workers reported to the Shocroom in 2013

• 8 is the mean of incidents of violence against health workers reported to the Shocroom in 2014.

• 10.22 is the mean of incidents of violence against health workers reported to the Shocroom in 2015.

We notice that despite the actions taken by the Ministry of Health, the number of reported attacks is increasing.

The research also found that 80% of the incidents of violence against health workers reported are physical.

The percentage of physical violence also increased between 2011 and 2015; it is respectively 78% in 2011 and 90% in 2015.

The actor of the violence is a relative of a patient in 61% of cases and in 39% the patient himself.

Workplace violence affects all health workers, both physicians and nurses, men and women, though some are more at risk than others. Emergency and ambulance staff are more affected by this violence.

22% of the incidents reported were followed by a cessation of work. And even when the victims kept working, there were high levels of stress and in some situations assistance from police.

Conclusions Violence towards health workers is a serious problem sometimes hindering the regular activity of health facilities by work interruptions it generates. In most cases, the actors are relatives of patients, which bring us to review the security measures in health settings.

The analysis of our data shows an increase of this flail in 2015, should we review our policies? Should we further strengthen our action plan in collaboration with other stakeholders such as the Ministry of Interior?