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Environmental activists gathered for a rally Tuesday outside Port Metro Vancouver's downtown offices, protesting a plan that could allow coal exports from the Lower Mainland to increase by up to 44 per cent.

Port Metro Vancouver, the company responsible for the operation and development of the Lower Mainland's harbours, is considering proposals to expand North Vancouver's Neptune Terminals and the Fraser Surrey Docks, which could boost the amount of coal exported in the region by an additional 14 million tonnes per year.

The port exported 32 million tonnes of coal in 2011, according to Port Metro Vancouver spokeswoman Barbara Joy-Kinsella.

The demonstration by over 50 activists from Voters Against Climate Change – which saw letters of protest taped to the glass walls of the port's Canada Place offices -- is the latest in a groundswell of opposition to potential port expansion.

The rally coincided with the release of a letter signed by B.C. Lung Association and the Public Health Association of B.C., among other groups, urging the port to reconsider the projects. In recent weeks, a group of environmental organizations and Mayor Gregor Robertson have also sent letters to Port Metro Vancouver expressing their concerns.

Protesters Tuesday cited a lack of accountability, environmental degradation and health risks among the reasons to cancel the coal expansion projects.

"We're just not going to stop," said Kevin Washbrook, director of Voters Taking Action Against Climate Change. "It's simply not fair to do things like this anymore."

Port Metro Vancouver's VP of social responsibility Duncan Wilson says that the organization has a "very robust consultation process."

Mr. Wilson said that about 600 people were present for a consultation on the Neptune Terminals project.

Furthermore, he said people are directing their anger at the wrong department. "That's a debate and discussion for the public to have with senior government," Mr. Wilson said, referring to complaints about coal exports from the Lower Mainland.

Port Metro Vancouver does not have jurisdiction over what kind of commodities gets shipped, said Mr. Wilson, only that the transportation of those materials is done responsibly.

Dr. Menn Biagtan, program manager for the B.C. Lung Association, believes there is little to no evidence that an increase in coal exports will not affect the health of B.C.'s population.

"It's not that we're opposing it -- it's that we need to know more," she said.

Dr. Biagtan said her organization is asking Port Metro Vancouver to produce evidence that the projects will not harm the population's health and the environment. "There needs to be answers to those questions."