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The evacuation and aid delivery was made possible by a surprise UN-brokered deal between the government and rebels to observe a three-day "humanitarian pause" in hostilities.
The truce -- due to be observed on Sunday when more people are set to be evacuated -- had eluded mediators in last month's fruitless first round of peace talks between government and opposition delegations in Switzerland.
The warring sides are due return to peace talks in Geneva Monday.
After a day of violence in the city, the Syrian Arab Red Crescent said it had finally distributed food and medical aid to civilians in the Old City neighbourhood.
The protracted siege has left residents starving, with people surviving on little other than olives and wild cereals, activists say.
"Although the team was shelled and fired upon we managed to deliver 250 food parcels, 190 hygiene kits and chronic diseases medicines," the Red Crescent said on Twitter.
The aid had been held up for months in a UN warehouse in a nearby government-controlled area.
The UN says it wants to distribute emergency rations for 2,500 people, along with medical kits, bedding, cash and other support for those leaving or those choosing to stay in the Old City.
Homs Governor Talal al-Barazi meanwhile told state news agency SANA that aid was distributed to two neighbourhoods, Bustan al-Diwan and Hamidiyeh.
Fighting threatens aid deliveries
The aid deliveries came despite attacks targeting the Red Crescent.
The relief organisation said shots were fired at aid trucks travelling to the stricken areas of Homs and mortar shells landed near them, wounding a driver.
SANA, however, gave a toll of four aid workers hurt and the Syrian Observatory for Human Rights reported two people killed in the area.
Barazi said two aid vehicles entered the Old City but "terrorist groups prevented the entrance of other vehicles by firing mortar rounds on the road".
The government refers to rebels battling to overthrow it as "terrorists".
He also blamed rebels for fighting that erupted in the morning, accusing them of breaking the truce.
"Terrorists broke the truce this morning in the Old City... by launching mortar rounds at the police headquarters in the Saa area," Barazi said.
But activists said the regime was responsible.
"The besieged areas have been pounded with mortar rounds since (Saturday) morning," said the Unified Media Office in the besieged neighbourhoods, adding the road to be used by aid convoys was hit.
The Observatory said fighting erupted in the early morning around the Old City as aid was due to enter the area, and that five blasts shook the district.
UN humanitarian chief Valerie Amos hailed the truce and said there were plans for more evacuations and aid deliveries in the next few days.
And a cleric in the rebel enclave, Abdul Hareth al-Khalidi, told AFP a second operation to evacuate civilians would take place on Sunday.
Barrel bombs rain on Aleppo
Homs, much of which has been reduced to rubble, was dubbed "the capital of the revolution" by activists before a bloody 2012 counter-offensive by regime forces recaptured much of the city.
The army blockaded the remaining rebel-held areas after their 2012 assault. They tightened the noose last summer by capturing the town of Qusayr, which cut off rebel supply lines to neighbouring Lebanon.
Elsewhere in the country on Saturday, at least 20 people were killed when regime helicopters dropped barrel bombs on the northern city of Aleppo, where the army is pressing an advance to recapture rebel-held areas, the Observatory said.
The monitoring group also said barrel bombs were dropped on Daraya, a rebel basion southwest of Damascus, while 16 people were killed in unrest in the southern province of Daraa.
The raids came as Al-Qaeda affiliate the Al-Nusra Front and allied Islamist rebel groups launched a new offensive against the jihadist Islamic State of Iraq and the Levant in Syria's oil-rich east.
On Friday, ISIL seized several rebel bases in Hasakeh province, north of Deir Ezzor, across the border from Iraq.
Deir Ezzor is a key conduit for ISIL to send weapons and fighters from Iraq into Syria.
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The truce -- due to be observed on Sunday when more people are set to be evacuated -- had eluded mediators in last month's fruitless first round of peace talks between government and opposition delegations in Switzerland.
The warring sides are due return to peace talks in Geneva Monday.
After a day of violence in the city, the Syrian Arab Red Crescent said it had finally distributed food and medical aid to civilians in the Old City neighbourhood.
The protracted siege has left residents starving, with people surviving on little other than olives and wild cereals, activists say.
"Although the team was shelled and fired upon we managed to deliver 250 food parcels, 190 hygiene kits and chronic diseases medicines," the Red Crescent said on Twitter.
The aid had been held up for months in a UN warehouse in a nearby government-controlled area.
The UN says it wants to distribute emergency rations for 2,500 people, along with medical kits, bedding, cash and other support for those leaving or those choosing to stay in the Old City.
Homs Governor Talal al-Barazi meanwhile told state news agency SANA that aid was distributed to two neighbourhoods, Bustan al-Diwan and Hamidiyeh.
Fighting threatens aid deliveries
The aid deliveries came despite attacks targeting the Red Crescent.
The relief organisation said shots were fired at aid trucks travelling to the stricken areas of Homs and mortar shells landed near them, wounding a driver.
SANA, however, gave a toll of four aid workers hurt and the Syrian Observatory for Human Rights reported two people killed in the area.
Barazi said two aid vehicles entered the Old City but "terrorist groups prevented the entrance of other vehicles by firing mortar rounds on the road".
The government refers to rebels battling to overthrow it as "terrorists".
He also blamed rebels for fighting that erupted in the morning, accusing them of breaking the truce.
"Terrorists broke the truce this morning in the Old City... by launching mortar rounds at the police headquarters in the Saa area," Barazi said.
But activists said the regime was responsible.
"The besieged areas have been pounded with mortar rounds since (Saturday) morning," said the Unified Media Office in the besieged neighbourhoods, adding the road to be used by aid convoys was hit.
The Observatory said fighting erupted in the early morning around the Old City as aid was due to enter the area, and that five blasts shook the district.
UN humanitarian chief Valerie Amos hailed the truce and said there were plans for more evacuations and aid deliveries in the next few days.
And a cleric in the rebel enclave, Abdul Hareth al-Khalidi, told AFP a second operation to evacuate civilians would take place on Sunday.
Barrel bombs rain on Aleppo
Homs, much of which has been reduced to rubble, was dubbed "the capital of the revolution" by activists before a bloody 2012 counter-offensive by regime forces recaptured much of the city.
The army blockaded the remaining rebel-held areas after their 2012 assault. They tightened the noose last summer by capturing the town of Qusayr, which cut off rebel supply lines to neighbouring Lebanon.
Elsewhere in the country on Saturday, at least 20 people were killed when regime helicopters dropped barrel bombs on the northern city of Aleppo, where the army is pressing an advance to recapture rebel-held areas, the Observatory said.
The monitoring group also said barrel bombs were dropped on Daraya, a rebel basion southwest of Damascus, while 16 people were killed in unrest in the southern province of Daraa.
The raids came as Al-Qaeda affiliate the Al-Nusra Front and allied Islamist rebel groups launched a new offensive against the jihadist Islamic State of Iraq and the Levant in Syria's oil-rich east.
On Friday, ISIL seized several rebel bases in Hasakeh province, north of Deir Ezzor, across the border from Iraq.
Deir Ezzor is a key conduit for ISIL to send weapons and fighters from Iraq into Syria.
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