This paper communicates the results of a detailed use-wear analysis of flint tools from Unit III of Nesher Ramla, central Israel, an open-air Middle Paleolithic site, dated to Marine Isotope Stage 5. The analyzed sample consists of 966 artifacts that represent major techno-typological categories; scrapers, tools with a lateral tranchet blow, naturally backed knives and other Middle Paleolithic artifact types. Most tools were associated with bone working activities, mainly scraping and cutting, suggesting both consumption and non-consumption-related practices. Results also suggest extensive butchering activities, but other applications are less common, especially the underrepresentation of armature, and plant and hide working is noteworthy. All in all, these patterns suggest a narrow range of activities. Most tools were used by their sharp edge, while the retouched edges bore weak use-related patterns. It is assumed that in some cases, the retouch served to facilitate the grip. The most widely used tools in Nesher Ramla were the naturally backed knives that according to technological studies were one of the goals of knapping at Nesher Ramla. Tools with a lateral tranchet blow, representing a cultural marker of the Nesher Ramla inhabitants, show evidence of multiple use of both retouched and non-retouched edges shaped by the lateral blow. Hafting traces are relatively rare in the analyzed sample.