Built on marshy land on the Left Bank of the Gironde, opposite Fort Pâté, Fort Médoc was a key part of Vauban's three-point defence system. Its purpose was to block the passage of ships between Île Pâté and Cussac in the Médoc. Fort Médoc was built in 1689-1690 on low-lying terrain with alluvial soil. The artillery battery was pointed towards Blaye and most of the structure was taken up to house it.

In order to keep the fort from being captured by soldiers disembarking from the estuary, it was necessary to build a structure able to resist such an attack. The square-shaped fort, oriented perpendicularly to the riverbank, consisted of four bastions linked by curtain walls. A demilune protected the imposing Porte Royale on the side furthest from the estuary. This vast entity was in turn protected by a covered walkway, a preliminary moat, and a main moat able to be filled with water by locks.

Two rows of barracks were built inside the square as well as a building to house the Major, a chapel, a bakery, and a gunpowder storage area. The barracks could accommodate 300 soldiers. However, the military role of Fort Médoc turned out to be rather negligible in the course of its history. In fact, it was never attacked. In 1716, thirteen 6 and 8 pound cannons and a rather limited number of cannonballs were nevertheless waiting. By 1789, only a few soldiers, mostly disabled veterans, and three old cannons attested to the fort's military vocation.

After periods of virtual abandon, followed by a renovation, the site was decommissioned by the army in 1916. It became the property of the commune of Cussac in 1930. This part of Vauban's project, executed by the architect Duplessy, is typical of fortifications designed by the French military strategist.

With the citadel of Blaye, its city walls and the Fort Paté, the Fort Médoc was listed in 2008 as UNESCO World Heritage Sites, as part of the 'Fortifications of Vauban' group.

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