DAMASCUS, Syria (AP) -- The U.S. and its allies dismissed the Syrian regime's referendum on a new constitution Sunday as a "farce" meant to justify the bloody crackdown on dissent.
But voters in government strongholds suggested why some Syrians have not joined the uprising against President Bashar Assad: Loyalty, distrust of the opposition and fear his fall will ignite a civil war.
U.S. Secretary of State Hillary Rodham Clinton called the poll "a cynical ploy" and urged Syrians who still support Assad to turn against him. A "farce" and a "sham vote" was how German Foreign Minister Guido Westerwelle described it.
"It's a phony referendum and it is going to be used by Assad to justify what he's doing to other Syrian citizens," Clinton said in an interview with CBS News in Rabat, Morocco.
"The longer you support the regime's campaign of violence against your brothers and sisters, the more it will stain your honor," she added, addressing Assad supporters, especially the military. "If you refuse, however, to prop up the regime or take part in attacks ... your countrymen and women will hail you as heroes."
While casting his vote at the state broadcasting headquarters, Assad showed no signs of giving in on international demands to end his crackdown. And as he has done in the past, he tried to deflect blame in other directions. He said Syria was under a "media attack."
"They may be stronger on the airwaves but we are stronger on the ground, and we aspire to win both on the ground and on the airwaves," he said in footage broadcast on state TV.
The U.S. and its European and Arab allies met Friday at a major international conference on the Syrian crisis in Tunisia, trying to forge a unified strategy to push Assad from power. They began planning a civilian peacekeeping mission to deploy after the regime falls.
The new constitution allows -- at least in theory -- for the formation of competing political parties and limits the president to two seven-year terms. Such change was unthinkable a year ago. Syria has been ruled by the Baath party since it seized power in a coup in 1963 and the Assad family has ruled since Bashar's father Hafez took over in another coup in 1970.
Even as the regime hailed the referendum as a giant step toward reform, its military kept up a crackdown that has been focused for the past three weeks on the opposition stronghold city of Homs. The city, parts of which are controlled by rebels, has come under intense shelling and hundreds have died, including two Western journalists.
The Britain-based Syrian Observatory for Human Rights said 18 civilians and 16 security personnel were killed Sunday, mostly in Homs. Another group, the Local Coordination Committees, said 45 people were killed nationwide, including 21 in Homs province.
The opposition called the referendum an empty gesture and boycotted voting, saying it will not ease the country's crisis. Supporters of the uprising say nothing short of Assad's ouster will end the bloodshed.
Activist groups estimate nearly 7,500 have died in 11 months of unrest.
Still the referendum demonstrated the support that Assad continues to enjoy among many Syrians and pointed to the difficulties of regime opponents -- both internal and external -- will face in trying to push him from power.
For the 41 years Assad's family has ruled Syria, it has used shrewd politics, a nearly omnipresent intelligence service and brute force to maintain power. Many of Syria's minorities -- Christians, Druse and Alawites, which include Assad -- count on the regime for protection on the understanding that they remain loyal. Many others have also benefited from regime ties.
These groups could be loath to see the regime fall, especially given how disorganized and unfamiliar those fighting Assad are. Regular state propaganda characterizing them and Islamist extremists and "armed gangs" also plays a role.
Even a successful vote -- results are expected Monday -- is unlikely to bring immediate change. Activists say too many people have died for them to accept anything less than Assad's ouster.
Legal expert Omran Zoubi, who helped draft the new document, said Assad's time in office so far doesn't count. That means he could serve two more terms after his current one ends 2014, keeping him in office until 2028.
In the capital Damascus, a regime stronghold where many in business and minority communities support Assad, many appeared eager to vote in what they considered a safe step toward reform.
"I'm here because I love my country," said housewife Fayzeh Fadel, wearing large sunglasses, jeans and high heels. She said she didn't want Syria to have a civil war like Libya or neighboring Iraq.
She and other voters spoke to foreign reporters who were accompanied by government minders.
"My biggest fear is civil war," said a woman named Lana at a pro-Assad demonstration downtown who declined to give her full name. "That's why we are standing by our president and Syrian institutions."
Nearby, hundreds of people waved Syrian flags and carried signs telling Assad: "We love you." Reflecting Assad's international allies, street peddlers sold flags for Russia, China and the Lebanese militant group Hezbollah.
Eleven months after protesters inspired by successful Arab Spring revolts in Tunisia and Egypt first took the streets, the real extent of Assad's support is unclear. Syria has no reliable polling, and authorities have restricted media work.
Most Damascus voters are likely regime supporters or people scared of unrest. Actual opponents probably stayed home.
The two main opposition groups, the Syrian National Council and the National Coordination Body for Democratic Change in Syria, called for a boycott, and other groups declared a general strike that appears to have been observed in some places.
Fewer voters turned out in the Damascus neighborhoods of Rukneddine and Barzeh, where anti-government protesters have recently demonstrated.
About 20 percent of shops were closed in Barzeh, and one voter said he had come from another center where there was "pressure not to vote ... intimidation and calls for public disobedience." He did not give his name for fear of reprisal.
Videos posted online Sunday by activists -- their primary means of communicating with the outside world -- gave a very different view.
Some showed protests against the vote outside of Damascus and Aleppo. One video from the northern Idlib province showed hundreds of men chanting, "To hell with them and their constitution."
A lighter video from elsewhere in Idlib showed dozens of men filing through a fake polling station and dropping their ballots in a trash bin.
The videos could not be independently verified.
Other videos showed the continued violence, as security forces shelled dissident areas and clashed with armed rebels.
The central city of Homs saw some of the day's worst violence. One video showed men firing a rocket-propelled grenade at a tank. Another from the neighborhood of Baba Amr, which has been subject to a weekslong government siege, showed huge plumes of smoke clouding the horizon while exploding shells boomed.
"The world is watching as Baba Amr is being destroyed and it says nothing," a voice says.
Hubbard reported from Beirut. Associated Press writers Matthew Lee, in Rabat, Morocco, Dale Gavlak, in Amman, Jordan, and Geir Moulson in Berlin contributed to this report.