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TRIPOLI, Libya — Fighters battling Moammar Gadhafi’s loyalists Monday entered the coastal city of Sirte from the east as residents fleeing the besieged city, one of the loyalists’ few remaining strongholds, warned of an escalating toll from the fighting. The foray by the former rebels, backed by a heavy bombardment from NATO warplanes, brought them to a traffic circle more than a mile from the city center, Reuters reported. In recent days, the rebels have struck deep into the city from the west, only to be beaten back by heavy resistance from Gadhafi fighters ensconced in the city.

As the anti-Gadhafi forces have struggled to unify Libya politically, the continuing, pitched battle for Sirte, one of only two remaining Gadhafi strongholds, has become one of their most urgent concerns. To declare an end to the conflict, they have suggested that they need to capture the city. They have struggled to do so, facing resistance from both Gadhafi troops and, residents say, from citizen volunteers who either fear the former rebels or remain loyal to the colonel.

And the frustrated response by the provisional government fighters — including pounding the city with heavy weapons — has raised fears of a mounting civilian toll. The International Committee for the Red Cross and other aid agencies have warned that food and medical supplies are running short and have told the combatants to avoid civilian casualties.

A doctor interviewed by The Associated Press, Eman Mohammed, said that many of the recent wounds at the city’s central Ibn Sina Hospital seemed to have been caused by shelling by the former rebels. There was no oxygen in the operating rooms, she said, and few staff members to treat patients.

Moussa Ibrahim, a spokesman for Gadhafi, told Reuters on Monday that he had been moving in and out of the besieged city, despite anti-Gadhafi fighters surrounding it on three sides. As for Gadhafi, Ibrahim declined to comment on his whereabouts, telling Reuters that the deposed leader was “very happy that he is doing his part in this great saga of the resistance.”